Active NPI
Nathan Modeen, LCSW
- Clinical Social Worker
- Grand Forks, ND
National Provider Identifier
1174949895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4828
- Practice address
- 1407 24TH Ave S Ste 100
Grand Forks, ND 58201-6761 - Phone
- (701) 239-3700
- NPI assigned
- Mar 6, 2014
- Sex
- Male
- 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 | 4828 | ND | Primary |
Addresses
Primary practice location
1407 24TH Ave S Ste 100
Grand Forks, ND 58201-6761
Mailing address
2101 Elm St N
Fargo, ND 58102-2417
Phone (701) 232-3241
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4828 | ND | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765238400000",
"number": "1174949895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 ELM ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581022417",
"telephone_number": "701-232-3241",
"fax_number": "701-237-2578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1407 24TH AVE S STE 100",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582016761",
"telephone_number": "701-239-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODEEN",
"first_name": "NATHAN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-06",
"last_updated": "2025-12-09",
"certification_date": "2025-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ND",
"license": "4828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.