Katie Ann Louise Shaw, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16455LICSW Issued in MN

Practice address

1875 Station Pkwy NW
Andover, MN 55304-3319

Phone

(763) 482-9598

NPI assigned

Nov 3, 2006

Last updated

Oct 2, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Katie Ann Louise Tilley Other name

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

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Love & Light Counseling, LLC

  • Clinical Social Worker
  • Andover, MN
  • NPI 1427876028
  Medicare reassignment NPD Authorized official
• Rum River Counseling, Inc.

  • Marriage & Family Therapist
  • Andover, MN
  • NPI 1073578472

  Clinical

  Medicare reassignment NPD
• Generations Community Support Service

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • W. St. Paul, MN
  • NPI 1861440919
  NPD (past)
• Hennepin County

  dba Hennepin County Mental Health Center

  • Psychiatry Physician
  • Minneapolis, MN
  • NPI 1780790345

  Clinical

  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1518046374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 147TH LN NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043124",
            "telephone_number": "612-840-9735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043319",
            "telephone_number": "763-482-9598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KATIE",
        "middle_name": "ANN LOUISE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "16455LICSW",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE MA",
            "identifier": "061637100",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "TILLEY",
            "middle_name": "ANN LOUISE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Maida Sejdic
• Wayne Senior, CEO
• Eva Jeptoo Serem, PHARMD.
• Victoria Lynn Seymour, DC
• Nancy Grace Shaddi
• Victoria Shear
• Shebah Home Health Care
• Brendan Sheehan, LPCC, LADC
• Leah Sherman, OTR/L
• Holly Shilling, DPT

• Clinical Social Worker in Andover, MN
• Providers in Andover, 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 Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.