Provider Demographics
NPI:1659090033
Name:BULLER, ERIN NICOLE (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:BULLER
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 1:10077 DOGWOOD ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5287
Mailing Address - Country:US
Mailing Address - Phone:651-443-1923
Mailing Address - Fax:
Practice Address - Street 1:825 41ST AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2910
Practice Address - Country:US
Practice Address - Phone:763-706-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN221711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical