Most Relevant Information
Provider Data
| NPI Number: | 1003504788 |
| Provider Name: | MICHELE J. LARSON MSW, LICSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 27669 |
Most Important Dates
| Enumeration Date: | 05/01/2023 |
| Last Updated: | 05/01/2023 |
Provider Practice Location
104 SERRA ST
MANKATO
MN
560019244
Practice Location Phone/Fax
| Phone: | 6085775742 |
| Fax: |
Provider Mailing Location
104 SERRA ST
MANKATO
MN
560019244
Provider Mailing Phone/Fax
| Phone: | 6085775742 |
| Fax: |