Provider Demographics
NPI:1316301039
Name:BLACIK, ERIN (LICSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BLACIK
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 1:10077 DOGWOOD ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5287
Mailing Address - Country:US
Mailing Address - Phone:763-489-7122
Mailing Address - Fax:
Practice Address - Street 1:10077 DOGWOOD ST NW STE 200
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5287
Practice Address - Country:US
Practice Address - Phone:763-489-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090065104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker