Healthcare Provider Details

I. General information

NPI: 1477481877
Provider Name (Legal Business Name): KATHLEEN NOELLE LARSON MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E EUCLID AVE STE 29
DES MOINES IA
50313-4564
US

IV. Provider business mailing address

1319 SE DELAWARE AVE APT 4
ANKENY IA
50021-4487
US

V. Phone/Fax

Practice location:
  • Phone: 515-207-5251
  • Fax:
Mailing address:
  • Phone: 515-207-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number118258
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0699
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: