Healthcare Provider Details

I. General information

NPI: 1144670571
Provider Name (Legal Business Name): JEREMY PERRETT MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E SUPERIOR ST STE 113
DULUTH MN
55802-2253
US

IV. Provider business mailing address

925 E SUPERIOR ST STE 113
DULUTH MN
55802-2253
US

V. Phone/Fax

Practice location:
  • Phone: 218-728-3931
  • Fax: 218-302-8728
Mailing address:
  • Phone: 218-310-8896
  • Fax: 218-206-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP16-1031
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: