Individual
KACIE E ERVASTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
1619 DAYTON AVE STE 325, SAINT PAUL, MN 55104-6495
(612) 616-9063
Mailing address
7432 BRYANT AVE S, RICHFIELD, MN 55423-3955
(612) 616-9063
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17141
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760892244
—
MN
Enumeration date
01/28/2022
Last updated
01/28/2022
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