Active NPI
Amanda Ellis, LICSW
- Clinical Social Worker
- Edina, MN
National Provider Identifier
1245680925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25258
- Practice address
- 7400 Metro Blvd Ste 335
Edina, MN 55439-2356 - Phone
- (651) 217-8600
- NPI assigned
- Jun 14, 2016
- 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 | 25258 | MN | Primary |
Addresses
Primary practice location
7400 Metro Blvd Ste 335
Edina, MN 55439-2356
Mailing address
7400 Metro Blvd Ste 335
Edina, MN 55439-2356
Phone (651) 217-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H300322582 | Other | MN | NGS MEDICARE |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160831000606 | MN | Practitioner - Clinical Social Worker | 7214223254 |
Reassigns benefits to 1 organization Practice locations: Roseville, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- A Time for Healing LLC
Practice addresses (Care Compare)
7400 Metro Blvd
Suite 335
Edina, MN 55439-2356
Phone (952) 388-8990
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Time for Healing, LLC | Clinical | Current | Accepting new patients |
| Brave Choices, Inc. | Clinical | Past | Accepting new patients |
| Amanda Ellis,LLC | Clinical | Past | Accepting new patients |
Locations
7400 Metro Blvd
Ste 335
Minneapolis, MN 55439
Phone (952) 388-8990
1611 County Road B W
Ste 214
Saint Paul, MN 55113
Phone (651) 217-8600
Organizations & group practices 3
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": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781827200000",
"number": "1245680925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7400 METRO BLVD STE 335",
"city": "EDINA",
"state": "MN",
"postal_code": "554392356",
"telephone_number": "651-217-8600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7400 METRO BLVD STE 335",
"city": "EDINA",
"state": "MN",
"postal_code": "554392356",
"telephone_number": "651-217-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "AMANDA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-14",
"last_updated": "2026-06-19",
"certification_date": "2026-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "25258",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NGS MEDICARE",
"identifier": "H300322582",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2026; 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.