Individual provider Active NPI

Mari M Wanzek, LCSW

  • Clinical Social Worker
  • Fargo, ND
National Provider Identifier
1295483337
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6213 Issued in ND
Practice address
6046 14TH St S
Fargo, ND 58104-7340
Phone
(701) 404-0997
Fax
(701) 566-8876
NPI assigned
Mar 17, 2022
Last updated
Aug 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6213 ND
Clinical Social Worker 1041C0700X 6213 ND Primary

Addresses

Primary practice location

6046 14TH St S
Fargo, ND 58104-7340

Mailing address

6046 14TH St S
Fargo, ND 58104-7340
Phone (701) 404-0997

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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

Enrollment IDStateProvider typePAC IDDetails
I20240819002287 ND Practitioner - Clinical Social Worker 0648718874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serene Counseling PLLCGroup PAC ID 5496161671, 3 clinicians

Practice addresses (Care Compare)

6046 14TH St S
Fargo, ND 58104-7226
Phone (701) 404-0997

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6213NDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Serene Counseling PLLC Social Worker CurrentSince Aug 1, 2024 Accepting new patients

Locations

6046 14th St S
Fargo, ND 58104
Phone (701) 471-7092

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723161600000",
    "number": "1295483337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6046 14TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047340",
            "telephone_number": "701-404-0997",
            "fax_number": "701-566-8876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6046 14TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047340",
            "telephone_number": "701-404-0997",
            "fax_number": "701-566-8876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANZEK",
        "first_name": "MARI",
        "middle_name": "M",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-17",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "6213",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "6213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.