Kelly M Nelson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19801 Issued in MN

Practice address

11708 Wayzata Blvd
Minnetonka, MN 55305-2014

Phone

(952) 544-0964

Fax

(952) 544-6405

NPI assigned

Mar 26, 2012

Last updated

Mar 26, 2012By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MN, SC, ME3 enrollments

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 3

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Doctor on Demand Professionals P CGroup PAC ID 9436464567, 113 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelly.nelson.1@30520.direct.athenahealth.com

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

• Doctor on Demand Professionals P C

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1174931448

  ME, SC

  Medicare reassignment Care Compare group NPD
• Allina Health System

  dba Allina Health Cancer Institute - Minneapolis

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1336185651
  NPD (past)
• Family Connections Counseling Center LLC

  dba Family Connections

  • Community/Behavioral Health Agency
  • Minnetonka, MN
  • NPI 1811228133
  NPD (past)

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332720000000",
    "number": "1417223371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4519 QUAIL AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554221134",
            "telephone_number": "763-222-6383",
            "fax_number": "952-544-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11708 WAYZATA BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553052014",
            "telephone_number": "952-544-0964",
            "fax_number": "952-544-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-26",
        "last_updated": "2012-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Nelezen
• Emily Nelsen, OD
• Cynthia Nelson
• Elizabeth Nelson, OTR
• Grace Nelson
• Megan D Nelson, LICSW
• Natalie Nelson
• Stephen R Nelson, DDS
• Terra Shanae Nelson, CRNP
• Megan J Nennig

• Clinical Social Worker in Minnetonka, MN
• Providers in Minnetonka, 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 Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.