Provider Demographics
NPI:1083806657
Name:MUSICH, ERRIN MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:ERRIN
Middle Name:MARIE
Last Name:MUSICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERRIN
Other - Middle Name:MARIE
Other - Last Name:DETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14000 NORTHDALE BLVD
Mailing Address - Street 2:STE I
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4663
Mailing Address - Country:US
Mailing Address - Phone:763-575-8086
Mailing Address - Fax:
Practice Address - Street 1:2277 HIGHWAY 36 W STE 160
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3830
Practice Address - Country:US
Practice Address - Phone:763-575-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP84399OtherHEALTH PARTNERS
MN61320MUOtherBCBS
MN085477000Medicaid
MN1052980OtherPREFERRED ONE
MN152556OtherU CARE
MN1052980OtherPREFERRED ONE