Provider Demographics
NPI:1881294304
Name:STRONS, DERJAUN
Entity type:Individual
Prefix:
First Name:DERJAUN
Middle Name:
Last Name:STRONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 JEFFERSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4740
Mailing Address - Country:US
Mailing Address - Phone:651-800-1225
Mailing Address - Fax:
Practice Address - Street 1:9300 NOBLE PKWY N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-5500
Practice Address - Country:US
Practice Address - Phone:763-236-5300
Practice Address - Fax:763-236-5250
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27285OtherLICENSED GRADUATE SOCIAL WORKER