| NPI | 1891171278 |
|---|---|
| Former Name | BRANDIE JEAN LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL 22616) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IA 111975) |
| 1041C0700X Social Worker Clinical (Licence: MN 17786) | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2024-05-02 |