Individual provider Active NPI

Allison M Wieser, LICSW

  • Clinical Social Worker
  • Moorhead, MN
National Provider Identifier
1245357201
Registry record updated Dec 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21058 Issued in MN
Practice address
1010 32ND Ave S
Moorhead, MN 56560-5001
Phone
(218) 233-7524
Fax
(218) 233-8627
NPI assigned
Mar 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 21058 MN Primary

Addresses

Primary practice location

1010 32ND Ave S
Moorhead, MN 56560-5001

Mailing address

1010 32ND Ave S
Moorhead, MN 56560-5001
Phone (218) 233-7524

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140108001769 MN Practitioner - Clinical Social Worker 9234367780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Mental Health Center IncGroup PAC ID 1759291891, 39 clinicians

Practice addresses (Care Compare)

1010 S 32ND Ave
Moorhead, MN 56560-5001
Phone (218) 233-7524

980 S Tower Rd
Fergus Falls, MN 56537-5505
Phone (218) 736-6987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21058MNMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Mental Health Center, Inc. CurrentSince Dec 11, 2013 Accepting new patients
Lakeland Mental Health Center Past Accepting new patients

Locations

980 S Tower Rd
Fergus Falls, MN 56537
Phone (218) 736-6987

1010 32nd Ave S
Moorhead, MN 56560
Phone (218) 233-7524

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386720000000",
    "number": "1245357201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 32ND AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605001",
            "telephone_number": "218-233-7524",
            "fax_number": "218-233-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 32ND AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605001",
            "telephone_number": "218-233-7524",
            "fax_number": "218-233-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESER",
        "first_name": "ALLISON",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2013-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.