Provider Demographics
NPI:1952046849
Name:SLOAN, LUKE (LICSW)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:SLOAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 QUINCY ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2316
Mailing Address - Country:US
Mailing Address - Phone:612-735-2372
Mailing Address - Fax:
Practice Address - Street 1:632 QUINCY ST NE APT 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2316
Practice Address - Country:US
Practice Address - Phone:612-735-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27290OtherOUT OF POCKET