Provider Demographics
NPI:1669190807
Name:LARSON, KELSEY ELAINE (MA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELAINE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 134TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7629
Mailing Address - Country:US
Mailing Address - Phone:320-761-7009
Mailing Address - Fax:
Practice Address - Street 1:18336 JOPLIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1773
Practice Address - Country:US
Practice Address - Phone:320-761-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist