Gretchen Suzanne Kirvida, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3068 Issued in MN

Practice address

7039 20TH Ave
Centerville, MN 55038-9737

Phone

(651) 288-0332

Fax

(651) 288-0493

NPI assigned

Dec 11, 2006

Last updated

Aug 3, 2020By the provider in NPPES

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

Other identifiers 5

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, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nest Professional Service CorpGroup PAC ID 6608239819, 3 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nest Professional Service Corp

  dba The NEST

  • Community/Behavioral Health Agency
  • Stillwater, MN
  • NPI 1508314071
  Medicare reassignment Care Compare group NPD
• Centerlife Counseling, LLC

  • Mental Health Counselor
  • Centerville, MN
  • NPI 1417283946

  Clinical

  NPD
• Lakes Area Human Services, Inc.

  • Community/Behavioral Health Agency
  • Forest Lake, MN
  • NPI 1700956646
  NPD (past)
• Midwest Center for Personal & Family Development PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Paul, MN
  • NPI 1285730903
  NPD (past)
• Pathway Virtu-Health

  • Family Nurse Practitioner
  • Shoreview, MN
  • NPI 1073134284
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1215097928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 397",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "55012",
            "telephone_number": "651-257-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7039 20TH AVE",
            "city": "CENTERVILLE",
            "state": "MN",
            "postal_code": "550389737",
            "telephone_number": "651-288-0332",
            "fax_number": "651-288-0493"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "882 SW 15th Street",
            "address_purpose": "LOCATION",
            "city": "Forest Lake",
            "state": "MN",
            "postal_code": "55025",
            "country_code": "US",
            "telephone_number": "651-464-2194",
            "fax_number": "651-464-5744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRVIDA",
        "first_name": "GRETCHEN",
        "middle_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "3068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169876",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17395900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP37279",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "205M6KI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP",
            "identifier": "4028602",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Jean Janke
• Danialle Olga Jensen, MA
• Katelin Elizabeth Johnson, DNP, APRN, FNP-C
• C. Scott Kammer, MD
• Brittany Dawn Kiel, BA
• Patricia Kniskern, PSY D, LP
• Jennifer A Krizan, LMFT
• Joanne Susan Kurzmann, MSW, LICSW
• Jennifer Lynn Larkey I, LPCC
• Kimberly Ann Lundholm-Eades, M.S., LMFT

• Clinical Social Worker in Centerville, MN
• Providers in Centerville, 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 Aug 3, 2020; 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.