Provider Demographics
NPI:1942422092
Name:STARR, LYNN ERICSON (MSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ERICSON
Last Name:STARR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 W 27TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3157
Mailing Address - Country:US
Mailing Address - Phone:952-920-5004
Mailing Address - Fax:952-746-2562
Practice Address - Street 1:7204 W 27TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3157
Practice Address - Country:US
Practice Address - Phone:952-920-5004
Practice Address - Fax:952-746-2562
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN147731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical