Julie Soderberg, Licsw

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

JULIE SODERBERG, LICSW

Practice address

5909 N Shore Dr
Duluth, MN 55804-9655

Phone

(218) 591-4715

Fax

(218) 669-0093

NPI assigned

Oct 28, 2024

Last updated

Dec 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Julie Ann Soderberg, LICSW

Title

Owner/Operator

Phone

(218) 591-4715

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734480000000",
    "number": "1487476834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 N SHORE DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558049655",
            "telephone_number": "218-591-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 N SHORE DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558049655",
            "telephone_number": "218-591-4715",
            "fax_number": "218-669-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIE SODERBERG, LICSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "SODERBERG",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "218-591-4715",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Duluth, MN
• Providers in Duluth, 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 Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.