Provider Demographics
NPI:1922549252
Name:CHADWICK, JAMES EDWIN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWIN
Last Name:CHADWICK
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 1:2446 ALDRICH AVE S APT 302
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2955
Mailing Address - Country:US
Mailing Address - Phone:612-723-3796
Mailing Address - Fax:
Practice Address - Street 1:595 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1730
Practice Address - Country:US
Practice Address - Phone:612-723-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN247711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical