Provider Demographics
NPI:1245591999
Name:CORRADI, LISA JO (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JO
Last Name:CORRADI
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:JO
Other - Last Name:KURPIERZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1880 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4085
Mailing Address - Country:US
Mailing Address - Phone:218-327-3000
Mailing Address - Fax:218-327-1871
Practice Address - Street 1:1880 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4085
Practice Address - Country:US
Practice Address - Phone:218-327-3000
Practice Address - Fax:218-327-1871
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical