Healthcare Provider Details

I. General information

NPI: 1649619727
Provider Name (Legal Business Name): ANDREW LEGRID LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 COUNTY ROAD B2 W
ROSEVILLE MN
55113-4338
US

IV. Provider business mailing address

1240 COUNTY ROAD B2 W
ROSEVILLE MN
55113-4396
US

V. Phone/Fax

Practice location:
  • Phone: 651-604-1406
  • Fax:
Mailing address:
  • Phone: 651-604-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30352
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: