Active NPI
Penny Gillen
- Addiction (Substance Use Disorder) Counselor
- Otsego, MN
National Provider Identifier
1225549520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 9245 Quantrelle Ave NE
Otsego, MN 55330-0168 - Phone
- (763) 746-9492
- NPI assigned
- Oct 13, 2017
- Last updated
- Oct 13, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
9245 Quantrelle Ave NE
Otsego, MN 55330-0168
Mailing address
1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nystrom & Associates, LTD | Past | Accepting new patients | |
| Family Support Services Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Sagent Behavioral Health
- Mental Health Counselor
- New Brighton, MN
- NPI 1467549220
-
dba Sagent Behavioral Health
- Clinical Social Worker
- New Brighton, MN
- NPI 1396750188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507852800000",
"number": "1225549520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SILVER LAKE RD NW",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "551121786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9245 QUANTRELLE AVE NE",
"city": "OTSEGO",
"state": "MN",
"postal_code": "553300168",
"telephone_number": "763-746-9492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEN",
"first_name": "PENNY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-13",
"last_updated": "2017-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Otsego, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.