Kelly Christina Bretson, MSW, LICSW

Key facts

NPI

1164948741

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

Practice address

7066 Stillwater Blvd N
Oakdale, MN 55128-3937

Phone

(651) 748-6359

NPI assigned

Aug 16, 2017

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

Other names

• Kelly Christina Dewey Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 16, 2017.

{
    "created_epoch": "1502841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502841600000",
    "number": "1164948741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 FURNESS PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551193275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7066 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283937",
            "telephone_number": "651-748-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRETSON",
        "first_name": "KELLY",
        "middle_name": "CHRISTINA",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-16",
        "last_updated": "2017-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DEWEY",
            "middle_name": "CHRISTINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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