Active NPI
Tracy Jan Jeremiason, MSW, LICSW
- Clinical Social Worker
- Brainerd, MN
National Provider Identifier
1295067577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 13130
- Practice address
- 520 NW 5TH St
Brainerd, MN 56401-2902 - Phone
- (218) 851-6242
- NPI assigned
- Feb 11, 2010
- 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 | 13130 | MN | Primary |
Addresses
Primary practice location
520 NW 5TH St
Brainerd, MN 56401-2902
Mailing address
520 NW 5TH St
Brainerd, MN 56401-2902
Phone (218) 851-6242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13130 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265846400000",
"number": "1295067577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 NW 5TH ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564012902",
"telephone_number": "218-851-6242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 NW 5TH ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564012902",
"telephone_number": "218-851-6242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEREMIASON",
"first_name": "TRACY",
"middle_name": "JAN",
"name_prefix": "Mrs.",
"credential": "MSW, LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-11",
"last_updated": "2010-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "13130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.