Individual provider Active NPI

Miranda D Barker, MSW LICSW

  • Clinical Social Worker
  • Mendota Heights, MN
National Provider Identifier
1093431686
Registry record updated Oct 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
25312 Issued in MN
Practice address
1370 Mendota Heights Rd
Mendota Heights, MN 55120-1281
Phone
(319) 504-5657
NPI assigned
Oct 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2022

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 25312 MN Primary

Addresses

Primary practice location

1370 Mendota Heights Rd
Mendota Heights, MN 55120-1281

Mailing address

1370 Mendota Heights Rd
Mendota Heights, MN 55120-1281
Phone (319) 504-5657

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
I20221103003164 MN Practitioner - Clinical Social Worker 2062889066 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25312MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mental Health Specialty Group PA CurrentSince Jan 1, 2026 Accepting new patients
Nystrom & Associates, LTD Clinical PastSince Apr 13, 2026 Accepting new patients

Locations

1560 Broadway
Ste 1600
Denver, CO 80202
Phone (480) 493-0900

729 Washington Ave N
Ste 600
Minneapolis, MN 55401
Phone (334) 463-3099

Organizations & group practices 2

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": "1665705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1093431686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 MENDOTA HEIGHTS RD",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201281",
            "telephone_number": "319-504-5657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 MENDOTA HEIGHTS RD",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201281",
            "telephone_number": "319-504-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARKER",
        "first_name": "MIRANDA",
        "middle_name": "D",
        "credential": "MSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-14",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota Heights, MN

Sources for this page

Verify at the official NPI Registry.