Juliana Renee Robertson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27882 Issued in MN

Practice address

24760 Hospital Dr
Redlake, MN 56671

Phone

(218) 679-0168

Fax

(218) 679-0187

NPI assigned

Oct 3, 2022

Last updated

Oct 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, MN2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PHS Indian HospitalGroup PAC ID 4789598731, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Red Lake Hospital Hospital, Redlake, MN, CCN 240206

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• PHS Indian Hospital

  • General Acute Care Hospital
  • Red Lake, MN
  • NPI 1508809765

  Single Specialty, TX

  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, MN

  Medicare reassignment NPD

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1194449249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3578 KIMMUR RD SW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015821",
            "telephone_number": "507-319-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24760 HOSPITAL DR",
            "city": "REDLAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-0168",
            "fax_number": "218-679-0187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JULIANA",
        "middle_name": "RENEE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Red Lake Homeless Shelter Inc.
• Red Lake Medication Assisted Recovery Services
• Red Lake Nation Youth Safe Harbor Inc
• Redlake Chemical Health Program Group Home (Redlake Group Home)
• Rayshayna Rose Roberts
• John Leo Millen Robinson, DDS
• Rons Transport LLC
• Elizabeth Vivian Rose, DMD
• Ethan Ryberg, PHARMD
• Vanessa Ryberg, PHARMD

• Clinical Social Worker in Red Lake, MN
• Providers in Red Lake, 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 Oct 3, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.