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NPI Code Detail

MEDICARE: MS. KRISTIN LINNEA LARSEN

MEDICARE: MS. KRISTIN LINNEA LARSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1932136538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTIN LINNEA LARSEN
Provider Business Mailing Address
First Line : 20500 S LA GRANGE RD
Second Line : STE 200S
City : FRANKFORT
State : IL
Zip : 60423-1356
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 W GRIGGS AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1234
Country : US
Telephone Number : 505-647-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/08/2007

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Directions to “ MS. KRISTIN LINNEA LARSEN ” Practice Location

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