Healthcare Provider Details

I. General information

NPI: 1629961503
Provider Name (Legal Business Name): EMILY ANNE LARSON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 LAKE CLUB DR STE 118
COLUMBUS OH
43232-3198
US

IV. Provider business mailing address

886 E BROAD ST APT C4
COLUMBUS OH
43205-1120
US

V. Phone/Fax

Practice location:
  • Phone: 614-266-2004
  • 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
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: