MEDICARE: COLETTE LARSON MSW, LISW-S

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	1041S0200X	School Social Worker
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841627502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLETTE LARSON MSW, LISW-S

Provider Business Mailing Address
First Line	:	4629 AICHOLTZ RD.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1557
Country	:	US
Telephone Number	:	513-752-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 AICHOLTZ RD.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-4524
Country	:	US
Telephone Number	:	513-752-1555
Fax Number	:	513-752-1555

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

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	03/17/2018

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