MEDICARE: HANS ERICKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245603166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANS ERICKSON

Provider Business Mailing Address
First Line	:	4535 BLAISDELL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-5030
Country	:	US
Telephone Number	:	718-753-9301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2653
Country	:	US
Telephone Number	:	612-200-3426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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Directions to “ HANS ERICKSON ” Practice Location

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