MEDICARE: MISS JASMYN ANITA CHARMICE SPICER MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	29342	MN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	306328	MN

General Provider Information

NPI Number	:	1639821671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JASMYN ANITA CHARMICE SPICER MSW, LICSW

Provider Business Mailing Address
First Line	:	1800 CHICAGO AVE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2592
Country	:	US
Telephone Number	:	612-879-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 CHICAGO AVE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2592
Country	:	US
Telephone Number	:	612-879-3115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	04/14/2026

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