Individual
MS. JOAN SAGEDAHL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSA LICSW
Contact information
Practice address
1280 NORTH BIRCH LAKE BLVD, WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER, WHITE BEAR LAKE, MN 55110-6708
(651) 429-8544
(651) 407-5301
Mailing address
1280 NORTH BIRCH LAKE BLVD, WHITE BEAR LAKE AREA COMMUNITY COUNSELING CENTER, WHITE BEAR LAKE, MN 55110-6708
(651) 429-8544
(651) 407-5301
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06420
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104651
UCARE MINNESOTA
MN
01
—
40115
BEHAVIORAL HEALTCARE PROV
MN
01
—
5H417LA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
11/14/2006
Last updated
07/08/2007
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