Provider Demographics
NPI:1598102873
Name:ERCHUL, NICOLETTE ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:ANN
Last Name:ERCHUL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W LAKE ST
Mailing Address - Street 2:STE 350
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2952
Mailing Address - Country:US
Mailing Address - Phone:612-979-2276
Mailing Address - Fax:651-925-0427
Practice Address - Street 1:1360 ENERGY PARK DR STE 340
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5298
Practice Address - Country:US
Practice Address - Phone:651-646-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN205171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400139162OtherMEDICARE PTAN
MN006958400Medicaid
MNH400139162OtherMEDICARE PTAN