Provider Demographics
NPI:1447338900
Name:LARSON, PAULA W (LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:W
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 SOUTH PACKERLAND DR
Mailing Address - Street 2:SUITE 104F
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-4130
Mailing Address - Country:US
Mailing Address - Phone:920-884-1144
Mailing Address - Fax:920-336-5959
Practice Address - Street 1:2631 SOUTH PACKERLAND DR
Practice Address - Street 2:SUITE 104 F
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-4130
Practice Address - Country:US
Practice Address - Phone:920-884-1144
Practice Address - Fax:920-336-5959
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16391231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical