Provider Demographics
NPI:1215707245
Name:SEDLACEK, TRICIA MAY (LICSW)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:MAY
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH ST E UNIT 3998
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2178
Mailing Address - Country:US
Mailing Address - Phone:651-468-7657
Mailing Address - Fax:
Practice Address - Street 1:1044 CENTERVILLE CIR
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-6346
Practice Address - Country:US
Practice Address - Phone:612-467-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical