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General NPI Number Information
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NPI Number | 1003433921
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Entity Type | Individual
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Provider Name | EDWARD ALAN YURICK MSW, LGSW
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Gender | Male
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone | 844-820-7391
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Fax |
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Provider Business Mailing Address
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Address Line | 13045 FALCON DR STE 100
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City | BAXTER
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State | MN
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Zip | 56425-4201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 69153
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23667
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License Number State | MN
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