Jade A. Erickson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21074 Issued in MN

Practice address

130 Wabasha St S
Suite 90
Saint Paul, MN 55107-1819

Phone

(651) 925-5531

Fax

(651) 450-2221

NPI assigned

Mar 3, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Expanse - a Minnesota Mental Health Ketamine and Psychedelic PsychotheGroup PAC ID 3779940937, 12 clinicians

Lyn-Lake Psychotherapy and Wellness LTDGroup PAC ID 9638581291, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lyn-Lake Psychotherapy and Wellness LTD.

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1609355163
  Medicare reassignment Care Compare group NPD
• Expanse - a Minnesota Mental Health Ketamine & Psychedelic Psychother

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1528726775
  Medicare reassignment Care Compare group
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1821276049
  Medicare reassignment NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1790909703
  NPD
• Guild

  • Case Management Agency
  • Saint Paul, MN
  • NPI 1659534725
  NPD (past)
• Guild

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1861514945
  NPD (past)
• Hennepin County

  • Psychiatry Physician
  • Minneapolis, MN
  • NPI 1780790345

  Clinical

  NPD (past)

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485475200000",
    "number": "1811389679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5536 26TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171928",
            "telephone_number": "612-860-3636",
            "fax_number": "651-450-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WABASHA ST S",
            "address_2": "SUITE 90",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551071819",
            "telephone_number": "651-925-5531",
            "fax_number": "651-450-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "JADE",
        "middle_name": "A.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2017-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW",
            "identifier": "21074",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher M Erickson, CRNA
• Dana Lynn Erickson, LPCC, LADC
• Dina Abedaziz Erickson, MSN, APRN, PMHNP-BC
• Donald Merle Erickson, D.D.S.
• Jacob Erickson, O.D.
• Jeffrey Dean Erickson
• Jennifer Erickson
• Kasey Erickson
• Lee Bradley Erickson, MA, LPCC
• Loren Erickson

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.