Provider Demographics
NPI:1750101481
Name:STRENGTHEN SOCIAL SKILLS
Entity type:Organization
Organization Name:STRENGTHEN SOCIAL SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEERS INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LICSW
Authorized Official - Phone:952-393-9884
Mailing Address - Street 1:313 MADISON AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8446
Mailing Address - Country:US
Mailing Address - Phone:952-393-9884
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-3356
Practice Address - Country:US
Practice Address - Phone:952-393-9884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083846711OtherNPI
1720385735OtherNPI