Kenzie Janson-Wolle, MSW, AASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28710 Issued in MN

Practice address

9245 Quantrelle Ave NE
Otsego, MN 55330-0168

Phone

(763) 746-9492

NPI assigned

Feb 27, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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.

• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD

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

{
    "created_epoch": "1424995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1265824296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9245 QUANTRELLE AVE NE",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553300168",
            "telephone_number": "763-746-9492"
        },
        {
            "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": "JANSON-WOLLE",
        "first_name": "KENZIE",
        "credential": "MSW, AASW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-27",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Husby Hursh
• Melodie Illies
• Infinite Health Collaborative, PA
• Integrity Independent Contracting, L.L.C.
• Kathryn M Isaacson, PA-C
• Ashley Johnson, LICSW
• Jane Pollock Johnson
• Kathleen L Johnson, BS, LADC, CBIS
• Melanie Johnson
• Samantha M Johnson, DPT

• All providers in Otsego, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.