Individual provider Active NPI

Kelly Nicole Gadola, LICSW

  • Clinical Social Worker
  • Minnetonka, MN
National Provider Identifier
1508449612
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
12301 Whitewater Dr Ste 101
Minnetonka, MN 55343-4157
Phone
(952) 999-6097
Fax
(952) 426-0508
NPI assigned
May 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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 Primary

Addresses

Primary practice location

12301 Whitewater Dr Ste 101
Minnetonka, MN 55343-4157

Mailing address

12301 Whitewater Dr Ste 101
Minnetonka, MN 55343-4157
Phone (952) 999-6097

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
I20251113001663 MN Practitioner - Clinical Social Worker 6103317581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12301 Whitewater Dr
Suite 101
Minnetonka, MN 55343-9447

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27662MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sonder Behavioral Health & Wellness, Inc. Clinical CurrentSince Nov 1, 2025 Accepting new patients
Relate Inc PastSince May 1, 2021 Accepting new patients

Locations

12301 Whitewater Dr
Ste 101
Minnetonka, MN 55343
Phone (952) 999-6097

Organizations & group practices 2

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": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1508449612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "952-999-6097",
            "fax_number": "952-426-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "952-999-6097",
            "fax_number": "952-426-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADOLA",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-05",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.