JEROME ALLEN LARSON PSS NPI 1063055192

NPI Information

  • NPI: 1063055192
  • Provider Name: JEROME ALLEN LARSON, PSS
  • Classification: Peer Specialist - 175T00000X
  • Entity Type: Individual
  • Address: 3090 N 53RD ST
    MILWAUKEE, WI
    ZIP 53210
  • Phone: (414) 254-4291

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NPI Details

Jerome Allen Larson, PSS is a peer specialist in Milwaukee, WI. The provider is individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. Jerome Allen Larson, PSS NPI is 1063055192. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3090 N 53RD ST
MILWAUKEE, WI
ZIP 53210-617
Phone: (414) 254-4291

The enumeration date for this NPI number is 10/22/2019 and was last updated on 10/22/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1175T00000XPeer SpecialistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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