Individual provider Active NPI

Jesse Francis Valentin, LICSW

  • Clinical Social Worker
  • St Louis Park, MN
National Provider Identifier
1477325454
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
29213 Issued in MN
Practice address
5354 Parkdale Dr FL 2
St Louis Park, MN 55416-1603
Phone
(651) 645-5323
NPI assigned
Oct 24, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 29213 MN Primary

Addresses

Primary practice location

5354 Parkdale Dr FL 2
St Louis Park, MN 55416-1603

Mailing address

5354 Parkdale Dr FL 2
Minneapolis, MN 55416-1603
Phone (888) 364-5977

Other practice location 1

430 Oak Grove St Apt 405
Minneapolis, MN 55403-3693
Phone (608) 658-5636

Other names 1

  • Jessica Ruth Hanner Former name

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
I20231221002649 MN Practitioner - Clinical Social Worker 9537519293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emily Program P CGroup PAC ID 5193623254, 49 clinicians

Practice addresses (Care Compare)

2265 Como Ave
Saint Paul, MN 55108-1737
Phone (651) 645-5323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Emily Program P C CurrentSince Nov 13, 2023 Accepting new patients

Locations

2265 Como Ave
Saint Paul, MN 55108

5354 Parkdale Dr
Fl 2
St Louis Park, MN 55416
Phone 6516455323 ext. 1480

Organizations & group practices 1

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": "1698105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1477325454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5354 PARKDALE DR FL 2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554161603",
            "telephone_number": "888-364-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5354 PARKDALE DR FL 2",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161603",
            "telephone_number": "651-645-5323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 Oak Grove St Apt 405",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554033693",
            "country_code": "US",
            "telephone_number": "608-658-5636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VALENTIN",
        "first_name": "JESSE",
        "middle_name": "FRANCIS",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HANNER",
            "middle_name": "RUTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.