MEDICARE: MELISSA LARSEN

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
1	1041C0700X	Clinical Social Worker	8911288	ID

General Provider Information

NPI Number	:	1467163378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LARSEN

Provider Business Mailing Address
First Line	:	133 MAIN AVE W STE 500
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-6580
Country	:	US
Telephone Number	:	208-829-9441
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 SHOSHONE ST E
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-6111
Country	:	US
Telephone Number	:	208-829-9441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	05/28/2026

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Directions to “ MELISSA LARSEN ” Practice Location

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