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General NPI Number Information
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NPI Number | 1285929968
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Entity Type | Individual
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Provider Name | DEBORAH KAY ERICKSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 2151 HAMLINE AVE N STE 204
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City | ROSEVILLE
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State | MN
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Zip | 55113-4226
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Country | US
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Telephone | 651-800-1127
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Fax | 651-925-0042
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Provider Business Mailing Address
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Address Line | 1162 ENGLEWOOD AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-1411
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Country | US
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Telephone | 651-485-1025
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Fax | 651-925-0042
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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 | 17401
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License Number State | MN
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