Healthcare Provider Details

I. General information

NPI: 1518416502
Provider Name (Legal Business Name): DANIELLE LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

PO BOX 1109
DEKALB IL
60115-7109
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-4875
  • Fax: 815-756-2944
Mailing address:
  • Phone: 815-756-4875
  • Fax: 815-756-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149.022693
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: