Lacey Severson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26356 Issued in MN

Practice address

2120 Clinton Ave
Minneapolis, MN 55404-2649

Phone

(952) 405-7190

NPI assigned

Feb 10, 2020

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

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

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 and National Provider Directory roles.

• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1063897593
  NPD

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

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1265064935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 QUINWOOD LN N APT 4114",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 CLINTON AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554042649",
            "telephone_number": "952-405-7190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2356 University Ave W",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551141853",
            "country_code": "US",
            "telephone_number": "952-405-7190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3705 Park Center Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554162504",
            "country_code": "US",
            "telephone_number": "952-405-7190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1349 Jersey Ave S",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554262231",
            "country_code": "US",
            "telephone_number": "952-405-7190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEVERSON",
        "first_name": "LACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "26356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Severson-McCormick
• Hayley Jeanmarie Severson
• Hayley R Severson
• Jamie Severson, RN
• Kassidy Severson, LMFT
• Marni Jean Severson, LICSW
• Michele Severson, OTR/L
• Shawn Marie Severson, MD
• Zoey C Severson X, LPC
• Anthony Lawrence Severt, MD

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, 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 Feb 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.