MEDICARE: HOPE THEORY PROFESSIONAL CORPORATION

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508753906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE THEORY PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	3821 29TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3103
Country	:	US
Telephone Number	:	314-629-7110
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 29TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3103
Country	:	US
Telephone Number	:	314-629-7110
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KAMRIE L.R. ERICSON
Credential	:	LICSW
Telephone Number	:	314-629-7110

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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