Individual
MR. CLARK J ERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
6701 PENN AVE SO, #301, RESONNCE CENTER, RICHFIELD, MN 55423-2093
(612) 861-6129
(612) 861-7589
Mailing address
6701 PENN AVE SO, #301, RESONNCE CENTER, RICHFIELD, MN 55423-2093
(612) 861-6129
(612) 861-7589
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1964
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143648
UCARE
MN
01
—
41-1576550
BHP
MN
01
—
504S6ER
BCBS
FM
01
—
62-60891
UBH
MN
01
—
901783600
MN CARE
MN
01
—
HP37280
HEALTHPARTNERS
MN
Enumeration date
10/10/2006
Last updated
02/02/2009
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