NPIMap

Organization Active NPI

Northern Waters Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hermantown, MN
National Provider Identifier
1316445455
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
NORTHERN WATERS CLINIC
Practice address
4899 Miller Trunk Hwy Ste 208
Hermantown, MN 55811-1582
Phone
(218) 391-9860
Fax
(218) 391-9860
NPI assigned
Jan 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Authorized official

Name
Dr. Melissa Ann Maki, NPNPI 1770683963
Title
Co-Owner
Phone
(218) 727-3888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0807X 2318 MN
Psychiatric/Mental Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WP0808X 2318 MN
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

4899 Miller Trunk Hwy Ste 208
Hermantown, MN 55811-1582

Mailing address

1702 Miller Trunk Hwy Ste 214
Duluth, MN 55811-4448

Other practice location 1

1702 Miller Trunk Hwy Ste 214
Duluth, MN 55811-4443
Phone (218) 391-9860

Other identifiers 1

IdentifierTypeStateIssuer
1295014520MedicaidMN

Other names 1

  • Northern Waters Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260409002244 MN Part B Supplier - Clinic/Group Practice 1355816182 Receives reassigned benefits from 6 practitioners
Practice locations: Duluth, MN

National Provider Directory

National Provider Directory

Locations

1702 Miller Trunk Hwy
Ste 214
Duluth, MN 55811
Phone (218) 391-9860

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764806400000",
    "number": "1316445455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 MILLER TRUNK HWY STE 214",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4899 MILLER TRUNK HWY STE 208",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558111582",
            "telephone_number": "218-391-9860",
            "fax_number": "218-391-9860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1702 Miller Trunk Hwy Ste 214",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558114443",
            "country_code": "US",
            "telephone_number": "218-391-9860",
            "fax_number": "218-260-4772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHERN WATERS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A",
        "authorized_official_last_name": "MAKI",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "218-727-3888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "163WP0807X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "MN",
            "license": "2318",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MN",
            "license": "2318",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295014520",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Waters Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hermantown, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.