# IZAAK DAVISON-KERWOOD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Izaak Davison-Kerwood, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790503704
- **Authorized official:** IZAAK RIVER DAVISON-KERWOOD LPCC (CEO)
- **Authorized official phone:** (612) 850-1006

## Contact information

- **Practice address:** 1713 TYLER ST NE UNIT 2, MINNEAPOLIS, MN 55413-1533
- **Practice address phone:** (612) 850-1006
- **Mailing address:** 1713 TYLER ST NE UNIT 2, MINNEAPOLIS, MN 55413-1533
- **Mailing address phone:** (612) 850-1006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2024
- **Last updated:** 12/20/2024