Individual
JUSTIN POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1101 E 78TH ST STE 100, BLOOMINGTON, MN 55420-1402
(952) 854-5034
Mailing address
1101 E 78TH ST STE 100, BLOOMINGTON, MN 55420-1402
(952) 854-5034
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24510
MN
Other
Enumeration date
05/09/2025
Last updated
05/09/2025
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