Healthcare Provider Details

I. General information

NPI: 1639821671
Provider Name (Legal Business Name): JASMYN ANITA CHARMICE SPICER MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JASMYN ANITA CHARMICE TAYLOR LICSW, LADC

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 CHICAGO AVE STE 100
MINNEAPOLIS MN
55404-2592
US

IV. Provider business mailing address

1800 CHICAGO AVE STE 100
MINNEAPOLIS MN
55404-2592
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-3115
  • Fax:
Mailing address:
  • Phone: 612-879-3115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29342
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306328
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: