Healthcare Provider Details

I. General information

NPI: 1073010914
Provider Name (Legal Business Name): KERRI EILEEN CLAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 XERXES AVE S STE 225
BLOOMINGTON MN
55431-1253
US

IV. Provider business mailing address

10201 WAYZATA BLVD STE 100
MINNETONKA MN
55305-1500
US

V. Phone/Fax

Practice location:
  • Phone: 612-701-5573
  • Fax:
Mailing address:
  • Phone: 952-544-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01769
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: