Individual provider Active NPI

Kylee Damm

  • Clinical Social Worker
  • Moorhead, MN
National Provider Identifier
1154906428
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
1547 30TH Ave S
Moorhead, MN 56560-5149
Phone
(218) 287-4338
NPI assigned
Mar 17, 2021
Last updated
Sep 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary
Specialist 174400000X NU

Addresses

Primary practice location

1547 30TH Ave S
Moorhead, MN 56560-5149

Mailing address

1547 30TH Ave S
Moorhead, MN 56560-5149

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
I20250114000314 MN Practitioner - Clinical Social Worker 6103354519 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31482MNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Solutions Behavioral Healthcare Professionals, PC Clinical CurrentSince Dec 5, 2024 Accepting new patients

Locations

1547 30th Ave S
Moorhead, MN 56560
Phone 21828743381113

891 Belsly Blvd
Moorhead, MN 56560
Phone (701) 412-2973

Organizations & group practices 1

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": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1154906428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 30TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605149",
            "telephone_number": "218-287-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMM",
        "first_name": "KYLEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-17",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.