Individual
ANDREA SUSAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
430 OAK GROVE SUITE #230, LORING PARK OFFICE BUILDING, MINNEAPOLIS, MN 55403-3253
(612) 870-0230
(612) 872-9170
Mailing address
430 OAK GROVE SUITE #230, LORING PARK OFFICE BUILDING, MINNEAPOLIS, MN 55403-3253
(612) 870-0230
(612) 872-9170
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0120
MN
103T00000X
Psychologist
LP1082
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59681LA
BC
—
Enumeration date
12/18/2006
Last updated
07/08/2007
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