Katie Ducklow, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26539

Practice address

7601 Wayzata Blvd
St Louis Park, MN 55426-1626

Phone

(612) 223-8898

NPI assigned

May 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1164959292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 ZANE AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554221059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261626",
            "telephone_number": "612-223-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCKLOW",
        "first_name": "KATIE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-19",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "46700",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "26539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Emory Driscoll, MA, LP
• DRN Health and Wellness
• Steven Duane, MD
• Deanne Dubbs, RPH
• Richard G Duchene, MA, LPCC
• Due North Chiropractic LLC
• Grace Taylor Duff
• Jill Dufner, LICSW
• Brooke Alison Dugdale, MD
• Isabelle Duguay, MA, LPCC, LCPC

• Clinical Social Worker in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.