Healthcare Provider Details

I. General information

NPI: 1740226851
Provider Name (Legal Business Name): KAREN T LARSON LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN T LARSON

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13045 FALCON DR STE 100
BAXTER MN
56425-4201
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 218-282-4746
  • Fax: 218-829-7649
Mailing address:
  • Phone: 612-464-6671
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP0943
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP0943
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0943
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberLP0943
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: