Provider Demographics
NPI:1881046282
Name:CARLSON, LYNN RENEE (LICSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RENEE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-714-9646
Mailing Address - Fax:651-714-9647
Practice Address - Street 1:1811 WEIR DR
Practice Address - Street 2:SUITE 270
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2272
Practice Address - Country:US
Practice Address - Phone:651-714-9646
Practice Address - Fax:651-714-9647
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN216621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical