Provider Demographics
NPI:1376950683
Name:SAVAGE, TERI JEAN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:JEAN
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2219
Mailing Address - Country:US
Mailing Address - Phone:218-513-6448
Mailing Address - Fax:
Practice Address - Street 1:1202 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2219
Practice Address - Country:US
Practice Address - Phone:218-513-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN215311041C0700X
MNAP14-1177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1376950683Medicaid