Provider Demographics
NPI:1720894926
Name:ERICSON, KAMRIE LYNNE REED (LICSW)
Entity type:Individual
Prefix:
First Name:KAMRIE
Middle Name:LYNNE REED
Last Name:ERICSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KAMRIE
Other - Middle Name:LYNEE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LMSW
Mailing Address - Street 1:3821 29TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3103
Mailing Address - Country:US
Mailing Address - Phone:314-629-7110
Mailing Address - Fax:
Practice Address - Street 1:1751 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7012
Practice Address - Country:US
Practice Address - Phone:952-892-7690
Practice Address - Fax:952-898-4930
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN297331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical