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NPI Code Detail

MEDICARE: JESSE TIMOTHY LARSON

MEDICARE: JESSE TIMOTHY LARSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1427908904
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE TIMOTHY LARSON
Provider Business Mailing Address
First Line : 3101 SUPERIOR DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1993
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3101 SUPERIOR DR NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1993
Country : US
Telephone Number : 507-292-1006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ JESSE TIMOTHY LARSON ” Practice Location

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