Provider Demographics
NPI:1053371476
Name:ERKKILA, GERILYN A (LICSW)
Entity type:Individual
Prefix:
First Name:GERILYN
Middle Name:A
Last Name:ERKKILA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GERILYN
Other - Middle Name:A
Other - Last Name:MANDERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:69 EXCHANGE ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1004
Mailing Address - Country:US
Mailing Address - Phone:651-232-3000
Mailing Address - Fax:
Practice Address - Street 1:69 EXCHANGE ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1004
Practice Address - Country:US
Practice Address - Phone:651-232-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN137631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN316538800Medicaid