Provider Demographics
NPI:1124749890
Name:LARSON, RACHEL MALLORN (MSW)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MALLORN
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2033
Mailing Address - Country:US
Mailing Address - Phone:608-434-3402
Mailing Address - Fax:
Practice Address - Street 1:1212 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1875
Practice Address - Country:US
Practice Address - Phone:606-434-5145
Practice Address - Fax:608-355-0755
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132608-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker