=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538618566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORRIE EHRBRIGHT LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2016
-----------------------------------------------------
Last Update Date | 08/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 W SUPERIOR ST STE 911
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55802-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-270-5555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1509 E SUPERIOR ST APT 203
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55812-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-270-4449
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 25763
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------