Healthcare Provider Details

I. General information

NPI: 1962251439
Provider Name (Legal Business Name): ERIN MORGAN CASANOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

IV. Provider business mailing address

3533 W SCHOOL ST UNIT 2
CHICAGO IL
60618-5419
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-1797
  • Fax: 651-925-0039
Mailing address:
  • Phone: 952-913-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: