Healthcare Provider Details

I. General information

NPI: 1336725720
Provider Name (Legal Business Name): AUTUMN MARIE JARVIS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN MARIE ERDMANN

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E 2ND ST
DULUTH MN
55805-1913
US

IV. Provider business mailing address

10408 US HIGHWAY 151
MANITOWOC WI
54220-9775
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8376
  • Fax:
Mailing address:
  • Phone: 715-410-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31486
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13129-121
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9823
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: