Deanna Wilde, MSW, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

31957 Issued in MN

Practice address

1708 1St St S
Willmar, MN 56201-4228

Phone

(218) 999-7750

NPI assigned

Dec 6, 2023

Last updated

Jul 14, 2026By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Modern Mojo

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Rapids, MN
  • NPI 1902344591
  NPD
• Divine Hope Counseling

  • Substance Abuse Rehabilitation Facility
  • Willmar, MN
  • NPI 1003042656
  NPD (past)

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

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1053188425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1708 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014228",
            "telephone_number": "218-999-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562014228",
            "telephone_number": "218-999-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "DEANNA",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-06",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "31957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003042656",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hailey Shaye Wester, LMFT
• White Drug Enterprises Inc (Thrifty White Pharmacy #022)
• Gregory Whittemore
• Cory James Wiegman, PTA
• Brenda Wiese, MSW LICSW
• Priscilla K Willander, PA-C
• Kristen Anne Williamson, RD, LDN
• Willmar Autism Services LLC
• Willmar Care Center LLC
• Willmar Chiropractic Clinic P.a.

• Social Worker in Willmar, MN
• Providers in Willmar, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.