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General NPI Number Information
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NPI Number | 1851002802
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Entity Type | Organization
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Legal Business Name | CORE CHOICE S.C.
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 1075 HICKORY ST
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City | ONALASKA
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State | WI
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Zip | 54650-3022
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Country | US
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Telephone | 906-251-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 425 STATE ST. P.O. BOX 1058
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City | LA CROSSE
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State | WI
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Zip | 54602
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Country | US
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Telephone | 715-724-2673
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERICA LEIGH LARSON
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Credential | DO
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Telephone | 715-724-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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