Healthcare Provider Details

I. General information

NPI: 1902730344
Provider Name (Legal Business Name): CASSANDRA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 W COLORADO AVE
COLORADO SPRINGS CO
80904-3838
US

IV. Provider business mailing address

1923 W COLORADO AVE
COLORADO SPRINGS CO
80904-3838
US

V. Phone/Fax

Practice location:
  • Phone: 303-600-8563
  • Fax: 877-805-7372
Mailing address:
  • Phone: 303-600-8563
  • Fax: 877-805-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: