Provider Demographics
NPI:1366761090
Name:LARSON, LINNEA A (MA,LP)
Entity type:Individual
Prefix:MS
First Name:LINNEA
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:MS
Other - First Name:LINNEA
Other - Middle Name:A
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10200 WILD DUCK PASS
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-5029
Mailing Address - Country:US
Mailing Address - Phone:612-281-4581
Mailing Address - Fax:
Practice Address - Street 1:10200 WILD DUCK PASS
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-5029
Practice Address - Country:US
Practice Address - Phone:612-281-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist