Amy Mallum, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

21852 Issued in MN

Practice address

413 SE 13TH St
Grand Rapids, MN 55744-0015

Phone

(218) 999-9908

Fax

(218) 999-9959

NPI assigned

Jun 16, 2015

Sex

Female

Sole proprietor

No

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

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

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Homes Inc.Group PAC ID 0648279554, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• North Homes, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Grand Rapids, MN
  • NPI 1790826550
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1447631452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 SE 13TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557440015",
            "telephone_number": "218-999-9908",
            "fax_number": "218-999-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 SE 13TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557440015",
            "telephone_number": "218-999-9908",
            "fax_number": "218-999-9959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLUM",
        "first_name": "AMY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Lyke, PTA
• Colleen Mackay, LADC
• Marissa Elana Baron Mahan, MD
• Mary Mahmood, LPCC
• Kate R. Makinen, MSW, LGSW, LADC
• Kelly Manner, RD
• Rich Marcis, LICSW
• Daniel J Margo, M.D.
• M. Jerry Zapanta Mariano, M.D.
• Ann Marie Martin, M.A., CCC-SLP

• Clinical Social Worker in Grand Rapids, MN
• Providers in Grand Rapids, 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 Sep 9, 2026; 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.