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General NPI Number Information
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NPI Number | 1124749890
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Entity Type | Individual
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Provider Name | RACHEL MALLORN LARSON MSW
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 1212 8TH ST STE 3
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City | BARABOO
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State | WI
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Zip | 53913-1875
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Country | US
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Telephone | 606-434-5145
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Fax | 608-355-0755
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Provider Business Mailing Address
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Address Line | 510 4TH AVE
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City | BARABOO
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State | WI
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Zip | 53913-2033
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Country | US
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Telephone | 608-434-3402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 132608-121
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License Number State | WI
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