Provider Demographics
NPI:1588559926
Name:LARSON, ABBY
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:LARSON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WARREN ST APT A35
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6907
Mailing Address - Country:US
Mailing Address - Phone:507-382-9403
Mailing Address - Fax:
Practice Address - Street 1:1400 WARREN ST APT A35
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6907
Practice Address - Country:US
Practice Address - Phone:507-382-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician