Provider Demographics
NPI:1477693851
Name:EMERY, CHRISTOPHER DAVID (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:EMERY
Suffix:
Gender:M
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 1:11141 ZEALAND AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3595
Mailing Address - Country:US
Mailing Address - Phone:763-442-8101
Mailing Address - Fax:
Practice Address - Street 1:11141 ZEALAND AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3595
Practice Address - Country:US
Practice Address - Phone:763-442-8101
Practice Address - Fax:763-951-3097
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6250783OtherMEDICA
919649800OtherMN MEDICAL ASSISTANCE
1033374OtherPREFERRED ONE
MN919649800Medicaid
229340OtherOPTUM
6250783OtherUBH
HP40382OtherHEALTHPARTNERS
MN207KEMOtherBCBS