Active NPI
Serene Eidem
- Social Worker
- Forest Lake, MN
National Provider Identifier
1144150434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 32549
- Practice address
- 1068 Lake St S Ste 109
Forest Lake, MN 55025-2633 - Phone
- (651) 982-4792
- Fax
- (651) 982-6035
- NPI assigned
- May 20, 2026
- Last updated
- May 20, 2026
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 32549 | MN | Primary |
Addresses
Primary practice location
1068 Lake St S Ste 109
Forest Lake, MN 55025-2633
Mailing address
1906 Iglehart Ave
Saint Paul, MN 55104-5139
Phone (651) 313-1898
Medicare participation
Medicare enrollment files- 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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779235200000",
"number": "1144150434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1906 IGLEHART AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551045139",
"telephone_number": "651-313-1898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1068 LAKE ST S STE 109",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550252633",
"telephone_number": "651-982-4792",
"fax_number": "651-982-6035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDEM",
"first_name": "SERENE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-20",
"last_updated": "2026-05-20",
"certification_date": "2026-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "32549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.