Provider Demographics
NPI:1346723442
Name:ERIN BRANDEL DYKHUIZEN, MA, MSW, LICSW LLC
Entity Type:Organization
Organization Name:ERIN BRANDEL DYKHUIZEN, MA, MSW, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:BRANDEL
Authorized Official - Last Name:DYKHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-722-2713
Mailing Address - Street 1:709 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4116
Mailing Address - Country:US
Mailing Address - Phone:612-722-2713
Mailing Address - Fax:
Practice Address - Street 1:905 JEFFERSON AVE STE 205-2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4741
Practice Address - Country:US
Practice Address - Phone:651-998-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN19717OtherBOARD OF SOCIAL WORK