Karin M Nystrom, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

20503 Issued in MN

Practice address

2649 Park Ave
Minneapolis, MN 55407-1006

Phone

(612) 676-1604

Fax

(612) 379-8235

NPI assigned

Oct 26, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Karin M Olson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288051200000",
    "number": "1396045225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7066 STILLWATER BLVD N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551283937",
            "telephone_number": "651-777-5222",
            "fax_number": "651-251-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2649 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071006",
            "telephone_number": "612-676-1604",
            "fax_number": "612-379-8235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "KARIN",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-26",
        "last_updated": "2010-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20503",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "816",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARIN",
            "last_name": "OLSON",
            "middle_name": "M",
            "credential": "LICSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nkoyo Nyong-Bassey
• Abigail Nyquist
• Christina Nyquist
• Darla Nicoelle Nyquist, RNC, NNP
• Nathaniel Nyquist, RD
• Jessicca Lee Nystuen, APRN
• Caroline Nzioka, RN
• Patrick J O Connor, MD
• Marcia A O Keefe, CRNA
• Brendn John O'Brien, D.C.

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; 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.