Individual
MRS. ROBERTA G. LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.I.C.S.W.
Contact information
Practice address
14502 COUNTY ROAD 6, PLYMOUTH, MN 55447-4555
(763) 591-0169
Mailing address
14502 COUNTY ROAD 6, PLYMOUTH, MN 55447-4555
(763) 591-0169
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
05177
MN
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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