Basic Information
| Provider Information | |||||||||
| NPI: | 1699199802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LECRONE | ||||||||
| FirstName: | ZACHERY | ||||||||
| MiddleName: | AVIR | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1309 | ||||||||
| Address2: | MS 21110Q | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554401309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123415000 | ||||||||
| FaxNumber: | 6123711673 | ||||||||
| Practice Location | |||||||||
| Address1: | 2220 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123415000 | ||||||||
| FaxNumber: | 6123711673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 23442 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.