Individual
JOHN O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
200 W 98TH ST, STE 107, BLOOMINGTON, MN 55420-4858
(612) 968-6097
Mailing address
200 W 98TH ST, STE 107, BLOOMINGTON, MN 55420-4858
(612) 968-6097
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14313
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205436246
EID
MN
05
—
689136500
—
MN
Enumeration date
04/23/2007
Last updated
11/16/2018
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