Provider Demographics
NPI:1588742837
Name:OVERSHINER, ERICA L (LICSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:OVERSHINER
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 1:1103 BROADWAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-0015
Mailing Address - Country:US
Mailing Address - Phone:320-228-9903
Mailing Address - Fax:320-238-7406
Practice Address - Street 1:1103 BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-0015
Practice Address - Country:US
Practice Address - Phone:320-228-9903
Practice Address - Fax:320-238-7406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545201041C0700X
MN168551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800001896Medicare Oscar/Certification
MN452442100Medicaid