Provider Demographics
NPI:1750930681
Name:JAWORSKI, EMILY ANN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:WILLEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:9069 GLACIER RD
Mailing Address - Street 2:
Mailing Address - City:ST BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1316
Mailing Address - Country:US
Mailing Address - Phone:952-567-1459
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY STE 110
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6451
Practice Address - Country:US
Practice Address - Phone:952-567-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN236881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical