STEPHANIE CLARICE LARSON DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067383

License Status

EXPIRED

Business

Title

First Name

STEPHANIE

Middle

CLARICE

Last Name

LARSON

Business Name

STEPHANIE CLARICE LARSON DO

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Family Medicine and OMT

Ever Disciplined

LastModifiedDate

10/25/2018