Individual provider Active NPI

Jennifer Stewart, MSW, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1558021568
Registry record updated Oct 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27502 Issued in MN
Practice address
1353 Kenneth St
Saint Paul, MN 55116-2607
Phone
(612) 437-7277
NPI assigned
Dec 19, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 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 27502 MN Primary

Addresses

Primary practice location

1353 Kenneth St
Saint Paul, MN 55116-2607

Mailing address

1353 Kenneth St
Saint Paul, MN 55116-2607

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
I20220811002346 MN Practitioner - Clinical Social Worker 4789067513 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
May accept Medicare assignment
Group practices
Lyn-Lake Psychotherapy and Wellness LTDGroup PAC ID 9638581291, 72 clinicians

Practice addresses (Care Compare)

621 W Lake St
Suite 350
Minneapolis, MN 55408-2952
Phone (612) 979-2276

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lyn-Lake Psychotherapy and Wellness LTD. CurrentSince Jul 15, 2022 Accepting new patients

Locations

621 W Lake St
Ste 350
Minneapolis, MN 55408
Phone (612) 547-9990

2900 Thomas Ave S
Ste 100
Minneapolis, MN 55416

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.

NPI Registry JSON

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

{
    "created_epoch": "1639872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761177600000",
    "number": "1558021568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1353 KENNETH ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1353 KENNETH ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162607",
            "telephone_number": "612-437-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "JENNIFER",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-19",
        "last_updated": "2025-10-23",
        "certification_date": "2025-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.