Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 105820 | MN |
NPI | 1396337366 |
---|---|
Provider Name | Morgan Larson |
First Address | Rochester, MN 55906-5407 |
Second Address | Rochester, MN 55906-5407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2021 |
Last Update Date | 20/10/2021 |