Basic Information
| Provider Information | |||||||||
| NPI: | 1881294304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRONS | ||||||||
| FirstName: | DERJAUN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 JEFFERSON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551024740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518001225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9300 NOBLE PKWY N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554435500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632365300 | ||||||||
| FaxNumber: | 7632365250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 27285 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 27285 | 01 | MN | LICENSED GRADUATE SOCIAL WORKER | OTHER |