Siri TS Eidsmo

Primary specialty

Social WorkerTaxonomy code 104100000X

License

30140 Issued in MN

Practice address

2118 Blaisdell Ave
Minneapolis, MN 55404-2415

Phone

(651) 201-2758

NPI assigned

Oct 8, 2021

Last updated

Oct 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1295497055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13579 BERKSHIRE LN",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553471702",
            "telephone_number": "218-341-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 BLAISDELL AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554042415",
            "telephone_number": "651-201-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EIDSMO",
        "first_name": "SIRI",
        "middle_name": "TS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306131",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "30140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Marie Eide, D.O.
• Michael Eide
• Russell Eide, PA-C
• Jay Henry Eidem, PHARMD
• Keith E Eidman, DO
• Erin Eidsness, MD
• Andrea Eiesland, OTR
• Mark H Eikenberry, M.D.
• Eiko Mizushima Integrative OT LLC
• Brady D Eilertson, APRN, CRNA

• Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.