Active NPI
Jessica Anderson, LICSW
- Social Worker
- Arden Hills, MN
National Provider Identifier
1508105222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 17600
- Practice address
- 3900 Northwoods Dr Ste 330
Arden Hills, MN 55112-6966 - Phone
- (651) 787-9600
- NPI assigned
- Feb 1, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 17600 | MN | |
| Social Worker | 104100000X | 17600 | MN | Primary |
Addresses
Primary practice location
3900 Northwoods Dr Ste 330
Arden Hills, MN 55112-6966
Mailing address
8170 33Rd Ave S
Bloomington, MN 55425-4516
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 |
|---|---|---|---|
| 17600 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Past | Accepting new patients |
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.
-
- Multi-Specialty Clinic/Center
- Andover, MN
- NPI 1194051151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615161600000",
"number": "1508105222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554254516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3900 NORTHWOODS DR STE 330",
"city": "ARDEN HILLS",
"state": "MN",
"postal_code": "551126966",
"telephone_number": "651-787-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JESSICA",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-01",
"last_updated": "2021-03-08",
"certification_date": "2021-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "17600",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "17600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arden Hills, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.