1114986916 NPI number — MS. ERIN PAIGE MCPHERSON MSW, LICSW

Table of content: MS. ERIN PAIGE MCPHERSON MSW, LICSW (NPI 1114986916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114986916 NPI number — MS. ERIN PAIGE MCPHERSON MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCPHERSON
Provider First Name:
ERIN
Provider Middle Name:
PAIGE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114986916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1204 7TH STREET SOUTH
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ST. CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-281-3988
Provider Business Mailing Address Fax Number:
320-281-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 7TH STREET SOUTH
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ST. CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-281-3988
Provider Business Practice Location Address Fax Number:
320-281-3989
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  13073 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 220G8MC . This is a "BLUE CROSS INDIV" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 227G0MC . This is a "BLUE CROSS GROUP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 114831 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 125138400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62-47529 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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