Healthcare Provider Details

I. General information

NPI: 1831825108
Provider Name (Legal Business Name): MEG JUSTISON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 MILLER TRUNK HWY STE 209
DULUTH MN
55811-4448
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 218-524-8889
  • Fax: 214-524-8890
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29042
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: