Individual provider Active NPI

Martha Myrna Rodriguez Quick, LICSW

  • Clinical Social Worker
  • Eagan, MN
National Provider Identifier
1568868164
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
22223 Issued in MN
Practice address
4185 Blackhawk Rd
Eagan, MN 55122-1701
Phone
(952) 237-3876
Fax
(651) 925-0084
NPI assigned
Nov 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 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 22223 MN Primary

Addresses

Primary practice location

4185 Blackhawk Rd
Eagan, MN 55122-1701

Mailing address

4185 Blackhawk Rd
Eagan, MN 55122-1701
Phone (952) 237-3876

Other practice location 1

445 Minnesota St Ste 1500
Saint Paul, MN 55101-2269
Phone (651) 877-6900

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
I20141210001786 MN Practitioner - Clinical Social Worker 1759603350 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22223MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Canvas Health, Inc. CurrentSince Sep 25, 2025 Accepting new patients

Locations

7066 Stillwater Blvd N
Saint Paul, MN 55128

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": "1415404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1568868164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 BLACKHAWK RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221701",
            "telephone_number": "952-237-3876",
            "fax_number": "651-925-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 BLACKHAWK RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551221701",
            "telephone_number": "952-237-3876",
            "fax_number": "651-925-0084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "445 Minnesota St Ste 1500",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012269",
            "country_code": "US",
            "telephone_number": "651-877-6900",
            "fax_number": "651-925-0084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ QUICK",
        "first_name": "MARTHA",
        "middle_name": "MYRNA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-08",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.