Individual provider Active NPI

Kaitlynn Halverson, MSW, LICSW

  • Clinical Social Worker
  • St Louis Park, MN
National Provider Identifier
1366116758
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
31273 Issued in MN
Practice address
7601 Wayzata Blvd
St Louis Park, MN 55426-1623
Phone
(612) 223-8898
NPI assigned
Aug 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 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 31273 MN Primary

Addresses

Primary practice location

7601 Wayzata Blvd
St Louis Park, MN 55426-1623

Mailing address

7601 Wayzata Blvd
St Louis Park, MN 55426-1623
Phone (612) 756-2428

Other names 1

  • Kaitlynn Lebrun Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20250318003512 MN Practitioner - Clinical Social Worker 6608398714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7601 Wayzata Blvd
Saint Louis Park, MN 55426-1623
Phone (612) 223-8898

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31273MNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Care Clinics, LLC CurrentSince Dec 28, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. Clinical CurrentSince Apr 15, 2025 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince Apr 15, 2025 Accepting new patients
Optum Behavioral Care of Colorado PC Past Accepting new patients

Locations

7400 W 109th St
Bloomington, MN 55438
Phone (952) 886-3268

1 Optum Cir
Eden Prairie, MN 55344
Phone (478) 234-8011

2000 Aldrich Ave S
Minneapolis, MN 55405
Phone (612) 223-8988

7601 Wayzata Blvd
St Louis Park, MN 55426
Phone (612) 223-8899

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1366116758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261623",
            "telephone_number": "612-756-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261623",
            "telephone_number": "612-223-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVERSON",
        "first_name": "KAITLYNN",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-09",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYNN",
            "last_name": "LEBRUN",
            "credential": "MSW, LGSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.