Active NPI
Jacqueline Rose Fendler, MSW
- Clinical Social Worker
- Fridley, MN
National Provider Identifier
1407204316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3162
- Practice address
- 550 Osborne Rd NE
Unity Hospital Emergency Department
Fridley, MN 55432-2718 - Phone
- (763) 236-5950
- Fax
- (763) 236-2666
- NPI assigned
- Jun 1, 2016
- Last updated
- Jun 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 3162 | MN | Primary |
Addresses
Primary practice location
550 Osborne Rd NE
Unity Hospital Emergency Department
Fridley, MN 55432-2718
Mailing address
550 Osborne Re
Unity Hospital Emergency Department
Fridley, MN 55423
Phone (763) 236-5950
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3162 | MN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464739200000",
"number": "1407204316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 OSBORNE RE",
"address_2": "UNITY HOSPITAL EMERGENCY DEPARTMENT",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "55423",
"telephone_number": "763-236-5950",
"fax_number": "763-236-2666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 OSBORNE RD NE",
"address_2": "UNITY HOSPITAL EMERGENCY DEPARTMENT",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322718",
"telephone_number": "763-236-5950",
"fax_number": "763-236-2666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENDLER",
"first_name": "JACQUELINE",
"middle_name": "ROSE",
"name_prefix": "Ms.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-01",
"last_updated": "2016-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "3162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.