Individual
LILY ROSE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 E 78TH ST, BLOOMINGTON, MN 55420-1400
(952) 234-6860
Mailing address
5790 145TH CT NW, RAMSEY, MN 55303-5684
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305897
MN
Other
Enumeration date
05/18/2020
Last updated
12/14/2020
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