Provider Demographics
NPI:1922479310
Name:LARSON, JENNIFER S (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 GREENVIEW DR SW STE 117
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1080
Mailing Address - Country:US
Mailing Address - Phone:507-926-3033
Mailing Address - Fax:
Practice Address - Street 1:1530 GREENVIEW DR SW STE 117
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1080
Practice Address - Country:US
Practice Address - Phone:507-926-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1034-124106H00000X
MN4702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist