Provider Demographics
NPI:1811389679
Name:ERICKSON, JADE A (LICSW)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:A
Last Name:ERICKSON
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 1:5536 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1928
Mailing Address - Country:US
Mailing Address - Phone:612-860-3636
Mailing Address - Fax:651-450-2221
Practice Address - Street 1:130 WABASHA ST S
Practice Address - Street 2:SUITE 90
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1819
Practice Address - Country:US
Practice Address - Phone:651-925-5531
Practice Address - Fax:651-450-2221
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN210741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21074OtherLICSW