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General NPI Number Information
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NPI Number | 1881699502
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Entity Type | Individual
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Provider Name | LARRY S GOODLUND MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 21693
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License Number State | WI
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