Provider Demographics
NPI:1427100312
Name:HARRISON, FREDERICK KENNETH (MS , LICSW)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:KENNETH
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MS , LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CRESTVIEW TER
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1205
Mailing Address - Country:US
Mailing Address - Phone:952-941-7861
Mailing Address - Fax:952-368-4625
Practice Address - Street 1:6 CRESTVIEW TER
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1205
Practice Address - Country:US
Practice Address - Phone:952-941-7861
Practice Address - Fax:952-368-4625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN060161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical