John Clifford Avery, LICSW
Individual provider Active NPI Clinical Social Worker · Little Falls, MN
NPI 1275869299 · NPPES record last updated Jul 25, 2022
Key facts
- NPI
- 1275869299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 12565 (MN)
- Practice address
- 12838 Highway 27
Little Falls, MN 56345-5209 - Phone
- (320) 360-4880
- Fax
- (320) 639-0220
- NPI assigned
- Oct 27, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
12838 Hwy 27
Little Falls, MN 56345-5209
Phone (320) 360-4880
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130226000067 | MN | Practitioner - Clinical Social Worker | 5890940761 | Practice locations: Little Falls, MN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12565 | MN | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 12565 | MN | Yes |
Addresses
Primary practice location
12838 Highway 27
Little Falls, MN 56345-5209
Mailing address
12838 Highway 27
Little Falls, MN 56345-5209
Phone (320) 360-4880
Other providers in Little Falls, MN
- Emily Appel
- Apple Tree Dental
- Michael Todd Arneson
- Maxine Schwartz Asnis
- Alyssa Dawn Athman
- Karilyn K Avery
- Joelle George Ayoub
- Baby'S on Broadway
- Rebecca Elizabeth Barton
- Melvin H Bauer
All providers in Little Falls, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.