Joan Gudorf Licsw

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

JOAN GUDORF LICSW

Practice address

4530 77TH St W Ste 325
Edina, MN 55435-5012

Phone

(612) 554-5095

NPI assigned

Mar 6, 2025

Organization subpart

No

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

Authorized official

Name

Joan Gudorf, LICSWNPI 1114617305

Title

Owner/Licensed Social Worker

Phone

(612) 555-5095

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joan Gudorf, LICSW

  • Clinical Social Worker
  • Hopkins, MN
  • NPI 1114617305
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1508664269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4808 WILFORD WAY",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351563",
            "telephone_number": "612-554-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 77TH ST W STE 325",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355012",
            "telephone_number": "612-554-5095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOAN GUDORF LICSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "GUDORF",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "OWNER/LICENSED SOCIAL WORKER",
        "authorized_official_telephone_number": "612-555-5095",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Edina, MN
• Providers in Edina, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.