Provider Demographics
NPI:1366275570
Name:DRISCOLL, TYLER JOSEPH (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 ALSETH RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-9724
Mailing Address - Country:US
Mailing Address - Phone:608-577-5741
Mailing Address - Fax:
Practice Address - Street 1:5820 ALSETH RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-9724
Practice Address - Country:US
Practice Address - Phone:608-577-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical