Individual provider Active NPI

Kristin Anita Dilley, MSW LICSW

  • Clinical Social Worker
  • Sartell, MN
National Provider Identifier
1376061697
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
101 Dehler Dr
Sartell, MN 56377-4407
Phone
(320) 253-3512
Fax
(320) 253-1037
NPI assigned
Sep 7, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

101 Dehler Dr
Sartell, MN 56377-4407

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789

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
I20211110000966 MN Practitioner - Clinical Social Worker 2860881018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

2405 8TH St S
Suite 200
Moorhead, MN 56560-4200
Phone (218) 331-4866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Family Support Services Inc. Mental Health CurrentSince Jul 2, 2023 Accepting new patients
Nystrom & Associates, LTD Clinical CurrentSince Aug 4, 2021 Accepting new patients

Locations

13603 80th Cir N
Maple Grove, MN 55369
Phone (763) 274-3120

2405 8th St S
Ste 200
Moorhead, MN 56560
Phone (218) 331-4866

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

101 Dehler Dr
Sartell, MN 56377
Phone (320) 253-3512

Organizations & group practices 2

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": "1504742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1376061697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DEHLER DR",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563774407",
            "telephone_number": "320-253-3512",
            "fax_number": "320-253-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLEY",
        "first_name": "KRISTIN",
        "middle_name": "ANITA",
        "credential": "MSW LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-07",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.