Active NPI
Clark J Erickson, LICSW
- Clinical Social Worker
- Richfield, MN
National Provider Identifier
1316035231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1964
- Practice address
- 6701 Penn Ave So
#301, Resonnce Center
Richfield, MN 55423-2093 - Phone
- (612) 861-6129
- Fax
- (612) 861-7589
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1964 | MN | Primary |
Addresses
Primary practice location
6701 Penn Ave So
#301, Resonnce Center
Richfield, MN 55423-2093
Mailing address
6701 Penn Ave So
#301, Resonnce Center
Richfield, MN 55423-2093
Phone (612) 861-6129
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41-1576550 | Other | MN | BHP |
| 901783600 | Other | MN | MN CARE |
| 143648 | Other | MN | UCARE |
| HP37280 | Other | MN | HEALTHPARTNERS |
| 504S6ER | Other | FM | BCBS |
| 62-60891 | Other | MN | UBH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1964 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233532800000",
"number": "1316035231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6701 PENN AVE SO",
"address_2": "#301, RESONNCE CENTER",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554232093",
"telephone_number": "612-861-6129",
"fax_number": "612-861-7589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6701 PENN AVE SO",
"address_2": "#301, RESONNCE CENTER",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554232093",
"telephone_number": "612-861-6129",
"fax_number": "612-861-7589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "CLARK",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2009-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "1964",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BHP",
"identifier": "41-1576550",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN CARE",
"identifier": "901783600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "143648",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP37280",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "504S6ER",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH",
"identifier": "62-60891",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.