Individual
DR. GORDON LEE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH. D
Contact information
Practice address
2600 N MAYFAIR RD STE 785, MILWAUKEE, WI 53226-1327
(414) 258-5704
(414) 258-8406
Mailing address
2600 N MAYFAIR ROAD, SUITE 785, MILWAUKEE, WI 53226-1327
(414) 258-5704
(414) 258-8406
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
50-057
WI
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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