1609909985 NPI number — MRS. BRENDA KAYE LARSON MA

Table of content: MRS. BRENDA KAYE LARSON MA (NPI 1609909985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609909985 NPI number — MRS. BRENDA KAYE LARSON MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSON
Provider First Name:
BRENDA
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELDY
Provider Other First Name:
BRENDA
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609909985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 892
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98625-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-673-1799
Provider Business Mailing Address Fax Number:
360-673-2248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 DAVIDDEAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98625-9417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-751-7213
Provider Business Practice Location Address Fax Number:
360-673-2248
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00011197 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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