Individual provider Active NPI

Jessica L Bernier, MSW, LICSW

  • Clinical Social Worker
  • Bloomington, MN
National Provider Identifier
1306654876
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
23877 Issued in MN
Practice address
200 W 96TH St Apt 3a
Bloomington, MN 55420-4329
Phone
(651) 621-0218
NPI assigned
Dec 30, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 23877 MN Primary

Addresses

Primary practice location

200 W 96TH St Apt 3a
Bloomington, MN 55420-4329

Mailing address

200 W 96TH St Apt 3a
Bloomington, MN 55420-4329
Phone (651) 621-0218

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

LicenseStateTypeSpecialty
23877MNMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1306654876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 96TH ST APT 3A",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204329",
            "telephone_number": "651-621-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W 96TH ST APT 3A",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554204329",
            "telephone_number": "651-621-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNIER",
        "first_name": "JESSICA",
        "middle_name": "L",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.