Healthcare Provider Details

I. General information

NPI: 1891608352
Provider Name (Legal Business Name): STEPHANIE LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PINE ST
WAYLAND MI
49348-1244
US

IV. Provider business mailing address

6515 CANNON FARMS DR NE
ROCKFORD MI
49341-8284
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-1127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: