Charissa Erickson, LICSW
Individual provider Active NPI Clinical Social Worker · Otsego, MN
NPI 1043940547 · NPPES record last updated Jun 16, 2022
Key facts
- NPI
- 1043940547
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 20028 (MN)
- Practice address
- 8081 Padre Way NE
Otsego, MN 55330-4543 - Phone
- (612) 963-0444
- NPI assigned
- Jun 16, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20028 | MN | MD | Clinical Social Worker |
Interoperability endpoints
- charissa.erickson.1@30520.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 20028 | MN | Yes |
Addresses
Primary practice location
8081 Padre Way NE
Otsego, MN 55330-4543
Mailing address
8081 Padre Way NE
Otsego, MN 55330-4543
Phone (612) 963-0444
Other providers in Otsego, MN
- Nathan J Dumm
- Deanna Dyrud
- David R. Edwards
- Lynda Ellen Eklund
- Jordan Enevold
- John William Eskola
- Lisa Anne Eskola
- Jennifer Lynn Esselman
- Evans Park, Inc
- Peter Moises Falcon
All providers in Otsego, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.