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General NPI Number Information
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NPI Number | 1225550791
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Entity Type | Individual
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Provider Name | JERRION ANDREW RICHARDSON MSSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 07/16/2017
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Last Update Date | 04/30/2022
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Provider Practice Location Address
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Address Line | 1614 HARMON PL STE 230
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-1929
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Country | US
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Telephone | 612-354-2592
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Fax |
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Provider Business Mailing Address
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Address Line | 4751 3RD ST NE
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City | FRIDLEY
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State | MN
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Zip | 55421-2128
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Country | US
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Telephone | 612-354-2592
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Fax | 612-474-0503
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23353
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License Number State | MN
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