Individual provider Active NPI

Kayla Thomas, LICSW

  • Clinical Social Worker
  • Minneapolis, MN
National Provider Identifier
1053172734
Registry record updated Jan 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
3333 University Ave SE
Minneapolis, MN 55414-3325
Phone
(612) 979-6148
NPI assigned
Jan 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X MN Primary

Addresses

Primary practice location

3333 University Ave SE
Minneapolis, MN 55414-3325

Mailing address

7021 Brooklyn Blvd Apt 318
Brooklyn Center, MN 55429-1363
Phone (612) 979-6148

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
I20240202002171 MN Practitioner - Clinical Social Worker 3577916865 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Soul Work Counseling, LLCGroup PAC ID 4789910233, 12 clinicians

Practice addresses (Care Compare)

11188 Zealand Ave N
Champlin, MN 55316-3594
Phone (763) 746-0842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fraser Child and Family Center CurrentSince Jan 15, 2024 Accepting new patients
Fraser PastSince Jan 21, 2024 Accepting new patients

Locations

9120 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 231-2590

3333 University Ave SE
Minneapolis, MN 55414
Phone (612) 253-1139

2400 W 64th St
Richfield, MN 55423
Phone (612) 767-5166

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1053172734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7021 BROOKLYN BLVD APT 318",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554291363",
            "telephone_number": "612-979-6148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 UNIVERSITY AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143325",
            "telephone_number": "612-979-6148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KAYLA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.