Individual provider Active NPI

Julie Katherine Wicker, MSW

  • Clinical Social Worker
  • Duluth, MN
National Provider Identifier
1548337173
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06443 Issued in MN
Practice address
25 N 12TH Ave E
Suite F
Duluth, MN 55805-2200
Phone
(218) 724-3122
Fax
(218) 724-4041
NPI assigned
Nov 29, 2006
Last updated
Oct 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2016

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 06443 MN Primary

Addresses

Primary practice location

25 N 12TH Ave E
Suite F
Duluth, MN 55805-2200

Mailing address

101 W 2ND St
Ste 200
Duluth, MN 55802-5004
Phone (218) 724-3122

Other identifiers 1

IdentifierTypeStateIssuer
965514000MedicaidMN

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
I20040721000065 MN Practitioner - Clinical Social Worker 3779563879 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06443MNMDClinical Social Worker
6443MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Iron Range Behavioral Services, LLC Clinical CurrentSince Jul 1, 2021 Accepting new patients
Harbor City Psychological Associates Clinical PastSince Jul 20, 2015 Accepting new patients

Locations

910 8th St S
Ste B
Virginia, MN 55792
Phone (218) 748-8500

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1548337173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 2ND ST",
            "address_2": "STE 200",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558025004",
            "telephone_number": "218-724-3122",
            "fax_number": "218-724-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N 12TH AVE E",
            "address_2": "SUITE F",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052200",
            "telephone_number": "218-724-3122",
            "fax_number": "218-724-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKER",
        "first_name": "JULIE",
        "middle_name": "KATHERINE",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "06443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "965514000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.