1427116417 NPI number — MRS. LINDA ALENE LARSEN LMSW

Table of content: MRS. LINDA ALENE LARSEN LMSW (NPI 1427116417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427116417 NPI number — MRS. LINDA ALENE LARSEN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSEN
Provider First Name:
LINDA
Provider Middle Name:
ALENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427116417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4202 FLAJOLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48642-9239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-837-2681
Provider Business Mailing Address Fax Number:
989-832-2132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 E ASHMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-832-2122
Provider Business Practice Location Address Fax Number:
989-832-2132
Provider Enumeration Date:
12/04/2006

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: 1041C0700X , with the licence number:  6801059113 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8008931660 . This is a "BLUECROSS BLUESHIELD OF M" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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