Healthcare Provider Details

I. General information

NPI: 1902141526
Provider Name (Legal Business Name): CHERI LYNN BRADY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 UNIVERSITY AVE SE
MINNEAPOLIS MN
55414-3325
US

IV. Provider business mailing address

3955 YORK AVE N
ROBBINSDALE MN
55422-2330
US

V. Phone/Fax

Practice location:
  • Phone: 612-728-5311
  • Fax:
Mailing address:
  • Phone: 763-536-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12998
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number467617
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: