Josette C Wynne, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

30694 Issued in MN

Practice address

C/O Aslan Institute
4141 Old Sibley Memorial Hwy
Eagan, MN 55122

Phone

(612) 578-7916

NPI assigned

Jan 4, 2022

Sex

Female

Sole proprietor

No

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 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

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Blue Thistle Psychotherapy, LLC

  • Adult Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1760247068
  Medicare reassignment NPD Authorized official
• Autism Society of Minnesota

  • Psychologist
  • Saint Paul, MN
  • NPI 1447236609
  NPD (past)
• Vanda Counseling and Psychological Services

  • Community/Behavioral Health Agency
  • Golden Valley, MN
  • NPI 1295131779
  NPD (past)

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

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1194486951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11525 RIVER HILLS DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373215",
            "telephone_number": "612-578-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "C/O ASLAN INSTITUTE",
            "address_2": "4141 OLD SIBLEY MEMORIAL HWY",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "612-578-7916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4969 Olson Memorial Hwy",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554225138",
            "country_code": "US",
            "telephone_number": "763-575-8086 x165",
            "fax_number": "320-774-0415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "JOSETTE",
        "middle_name": "C",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• World Pediatrics
• Karlee Jo Wortham, APRN, FNP-C
• Worthington Wellness Center
• Heather Lynn Worthington, D.C.
• Magan Wrape
• Vang Xiong Skibbie, PSYD LP
• Kao Hlee Xiong, DC
• Vang Houa Xiong
• Xia Xiong
• Elizza Yang

• Clinical Social Worker in Eagan, MN
• Providers in Eagan, 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 Apr 19, 2024; 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.