Healthcare Provider Details

I. General information

NPI: 1992349302
Provider Name (Legal Business Name): LAURA LARSON-CODY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 10TH AVE S
WAITE PARK MN
56387-1400
US

IV. Provider business mailing address

1547 30TH AVE S
MOORHEAD MN
56560-5149
US

V. Phone/Fax

Practice location:
  • Phone: 612-767-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59980
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: