Individual
GARY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
180 GROTTO ST S, SAINT PAUL, MN 55105-3505
(651) 224-1395
Mailing address
4846 MOON LAKE CIR, SAINT PAUL, MN 55127-7049
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/22/2006
Last updated
07/08/2007
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