Angella Lynn Cekalla, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21873 Issued in MN

Practice address

11615 State Ave
Brainerd, MN 56401-7306

Phone

(218) 849-0345

Fax

(651) 431-7437

NPI assigned

Sep 29, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Angella Lynn Carter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1356013239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 BEDOW RD",
            "city": "FORT RIPLEY",
            "state": "MN",
            "postal_code": "564491579",
            "telephone_number": "218-849-0345",
            "fax_number": "651-431-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11615 STATE AVE",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564017306",
            "telephone_number": "218-849-0345",
            "fax_number": "651-431-7437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEKALLA",
        "first_name": "ANGELLA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELLA",
            "last_name": "CARTER",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "credential": "LGSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Stefany Carvalho, DPM
• Richard V Castle, D.O.
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• Sonya K Chamberlain, LM, CPM

• All providers in Brainerd, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.