Active NPI
Laura Louise Evensen, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1104122605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19385
- Practice address
- 4306 Bryant Ave S
Minneapolis, MN 55409-1709 - Phone
- (952) 649-6826
- Fax
- (652) 925-0433
- NPI assigned
- Jan 31, 2011
- Last updated
- May 4, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 19385 | MN | Primary |
Addresses
Primary practice location
4306 Bryant Ave S
Minneapolis, MN 55409-1709
Mailing address
5917 Dupont Ave S
Minneapolis, MN 55419-2110
Phone (952) 232-9933
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19385 | MN | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525392000000",
"number": "1104122605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5917 DUPONT AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554192110",
"telephone_number": "952-232-9933",
"fax_number": "651-925-0433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4306 BRYANT AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554091709",
"telephone_number": "952-649-6826",
"fax_number": "652-925-0433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVENSEN",
"first_name": "LAURA",
"middle_name": "LOUISE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-31",
"last_updated": "2018-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "19385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.