Healthcare Provider Details

I. General information

NPI: 1508797358
Provider Name (Legal Business Name): LOUANN LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MINNESOTA AVE
BIG LAKE MN
55309-8800
US

IV. Provider business mailing address

11899 GROUSE ST NW
MINNEAPOLIS MN
55448-1951
US

V. Phone/Fax

Practice location:
  • Phone: 763-262-7211
  • Fax:
Mailing address:
  • Phone: 763-489-8917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01034369
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: