=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851683874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L STRICK LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2011
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5905 GOLDEN VALLEY RD 100
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-4463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-225-4052
-----------------------------------------------------
Fax | 763-225-4081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22426 SAINT FRANCIS BLVD
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-9670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-753-7310
-----------------------------------------------------
Fax | 763-753-6529
-----------------------------------------------------
=====================================================
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 | 19294
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------