Tammy M Gagnon, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22386 Issued in MN

Practice address

11 Civic Center PLZ Ste 1615
Mankato, MN 56001-7710

Phone

(507) 345-4679

Fax

(507) 345-8685

NPI assigned

May 19, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• House of Hope, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Mankato, MN
  • NPI 1881692192
  Medicare reassignment NPD
• Addictions and Stress Clinics LTD

  dba ASC Psychological Services

  • Psychologist
  • Mankato, MN
  • NPI 1376820118
  NPD

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

{
    "created_epoch": "1526688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1013408681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ STE 205",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017718",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CIVIC CENTER PLZ STE 1615",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560017710",
            "telephone_number": "507-345-4679",
            "fax_number": "507-345-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "TAMMY",
        "middle_name": "M",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-19",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riley Marie Fritz
• Functional Chiropractic Rehab, PLLC
• Megumi Furuta
• Fussy Chiropractic Health and Wellness PLLC (HealthSource of Mankato)
• Brittany Christina Fussy, DC
• Charlotte Eileen Gallagher, LIC. ACUPUNCTURIST
• Griffin H Gallagher
• Carroll M Galvin, MD
• Amvrine Ganguly, MD
• Clare Elizabeth Gannon, FNP-C

• Clinical Social Worker in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.