Provider Demographics
NPI:1194531517
Name:LARSEN, ANDREW (BA, MLS, CHI, CMI)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:BA, MLS, CHI, CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 WILLIAMS FORK TRL APT 110
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3408
Mailing Address - Country:US
Mailing Address - Phone:719-963-5775
Mailing Address - Fax:
Practice Address - Street 1:5110 WILLIAMS FORK TRL APT 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3408
Practice Address - Country:US
Practice Address - Phone:719-963-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter