Healthcare Provider Details

I. General information

NPI: 1346899580
Provider Name (Legal Business Name): ERIK LARSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 34TH AVE E
ALEXANDRIA MN
56308-2599
US

IV. Provider business mailing address

702 34TH AVE E
ALEXANDRIA MN
56308-2599
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-2400
  • Fax: 320-762-8047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26271
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: