Provider Demographics
NPI:1285159145
Name:SIMONSON, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:LAVENTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW, LADC
Mailing Address - Street 1:1018 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-1300
Mailing Address - Country:US
Mailing Address - Phone:320-402-0115
Mailing Address - Fax:
Practice Address - Street 1:1018 5TH ST SE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1300
Practice Address - Country:US
Practice Address - Phone:320-402-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302209101YA0400X
MN287891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)