Active NPI
Kerry Edna McDonald, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1205928363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13929
- Practice address
- 5208 Bloomington Ave S
Minneapolis, MN 55417 - Phone
- (612) 205-9745
- Fax
- (612) 822-2116
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 13929 | MN | Primary |
Addresses
Primary practice location
5208 Bloomington Ave S
Minneapolis, MN 55417
Mailing address
5208 Bloomington Ave S
Minneapolis, MN 55417
Phone (612) 205-9745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 924691600 | Medicaid | MN |
Other names 1
- Mrs. Kerry McDonald Mokalla, Licsw, LLC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13929 | MN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manzanita Therapy, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Minneapolis, MN
- NPI 1760805600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493596800000",
"number": "1205928363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5208 BLOOMINGTON AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55417",
"telephone_number": "612-205-9745",
"fax_number": "612-822-2116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5208 BLOOMINGTON AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55417",
"telephone_number": "612-205-9745",
"fax_number": "612-822-2116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "KERRY",
"middle_name": "EDNA",
"name_prefix": "Mrs.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2017-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "13929",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "924691600",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KERRY",
"last_name": "MOKALLA, LICSW, LLC",
"middle_name": "MCDONALD",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.