Individual provider Active NPI

Joni Lea Medenwald, MSW, LSW

  • Clinical Social Worker
  • Moorhead, MN
National Provider Identifier
1003063751
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21692 Issued in MN
Practice address
815 37TH Ave S
Moorhead, MN 56560-5524
Phone
(701) 451-4811
Fax
(651) 925-0057
NPI assigned
Aug 25, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 3977 ND
Clinical Social Worker 1041C0700X 21692 MN Primary

Addresses

Primary practice location

815 37TH Ave S
Moorhead, MN 56560-5524

Mailing address

1201 25TH St S
Fargo, ND 58103-2311
Phone (701) 451-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130102000065 MN Practitioner - Clinical Social Worker 7113102930 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3977NDMDSocial Worker

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1003063751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 25TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032311",
            "telephone_number": "701-451-4900",
            "fax_number": "651-925-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 37TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605524",
            "telephone_number": "701-451-4811",
            "fax_number": "651-925-0057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDENWALD",
        "first_name": "JONI",
        "middle_name": "LEA",
        "credential": "MSW, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "3977",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.