1538693593 NPI number — MS. KRISTINA LARSSON MA, BCBA, LBA

Table of content: MS. KRISTINA LARSSON MA, BCBA, LBA (NPI 1538693593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538693593 NPI number — MS. KRISTINA LARSSON MA, BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARSSON
Provider First Name:
KRISTINA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, BCBA, LBA
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:
1538693593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 S GABOURI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINTE GENEVIEVE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63670-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-608-0484
Provider Business Mailing Address Fax Number:
314-845-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11140 S TOWNE SQ
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63123-7830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-845-3900
Provider Business Practice Location Address Fax Number:
314-845-3901
Provider Enumeration Date:
04/17/2017

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: 251S00000X , with the licence number:  2017010137 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 2017010137 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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