Healthcare Provider Details

I. General information

NPI: 1477693851
Provider Name (Legal Business Name): CHRISTOPHER DAVID EMERY MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11141 ZEALAND AVE N
CHAMPLIN MN
55316-3595
US

IV. Provider business mailing address

11141 ZEALAND AVE N
CHAMPLIN MN
55316-3595
US

V. Phone/Fax

Practice location:
  • Phone: 763-442-8101
  • Fax: 763-951-3097
Mailing address:
  • Phone: 763-442-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10089
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6250783
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerMEDICA
# 2
Identifier919649800
Identifier TypeOTHER
Identifier State
Identifier IssuerMN MEDICAL ASSISTANCE
# 3
Identifier1033374
Identifier TypeOTHER
Identifier State
Identifier IssuerPREFERRED ONE
# 4
Identifier919649800
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 5
Identifier229340
Identifier TypeOTHER
Identifier State
Identifier IssuerOPTUM
# 6
Identifier6250783
Identifier TypeOTHER
Identifier State
Identifier IssuerUBH
# 7
IdentifierHP40382
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHPARTNERS
# 8
Identifier207KEM
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: