Provider Demographics
NPI:1306490461
Name:LARGE, ALISON JEAN (LAC)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:JEAN
Last Name:LARGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:JEAN
Other - Last Name:LEBIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:5910 NW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3556
Mailing Address - Country:US
Mailing Address - Phone:816-216-1218
Mailing Address - Fax:816-216-1633
Practice Address - Street 1:5910 NW 63RD TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3556
Practice Address - Country:US
Practice Address - Phone:816-216-1218
Practice Address - Fax:816-216-1633
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006409171100000X
152265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist