Provider Demographics
NPI:1225550791
Name:RICHARDSON, JERRION ANDREW (MSSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JERRION
Middle Name:ANDREW
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2128
Mailing Address - Country:US
Mailing Address - Phone:612-354-2592
Mailing Address - Fax:612-474-0503
Practice Address - Street 1:1614 HARMON PL STE 230
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1929
Practice Address - Country:US
Practice Address - Phone:612-354-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN233531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical