Larson, Jody B
Larson, Jody B is an individual health care provider with primary practice located at 1325 Angels Path , De Pere WI 54115-4050. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Larson, Jody B can be contacted via phone (920) 338-2855.Contact Information
Primary practice address
1325 Angels Path
De Pere WI 54115-4050
Phone: (920) 338-2855
Fax: (920) 338-9270
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Art Therapist | 221700000X | 62-036 | Wisconsin |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | 2479-125 | Wisconsin |
Profile Details
| NPI number | 1750590477 |
|---|---|
| LBN Legal business name | Larson, Jody B |
| Credentials | LPC, ATRL |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 21st, 2007 |
| Last updated | Dec 29th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750590477 | NPPES |
| Other | 497057 | NATIONAL BOARD FOR CERTIFIED COUNSELORS |
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