Healthcare Provider Details

I. General information

NPI: 1992766018
Provider Name (Legal Business Name): MARLYS J LARSON LISW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2981 S. ORILLA RD.
CUMMING IA
50061
US

IV. Provider business mailing address

2981 S ORILLA RD
CUMMING IA
50061-7502
US

V. Phone/Fax

Practice location:
  • Phone: 515-981-0869
  • Fax:
Mailing address:
  • Phone: 515-981-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00112
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00112
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: