Individual provider Active NPI

Rebecca Louise Nicklay, LICSW

  • Clinical Social Worker
  • Bloomington, MN
National Provider Identifier
1588361174
Registry record updated May 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
15961 Issued in MN
Practice address
7920 Old Cedar Ave S
Bloomington, MN 55425-1207
Phone
(952) 428-1899
Fax
(952) 428-1723
NPI assigned
Feb 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2023

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 15961 MN Primary

Addresses

Primary practice location

7920 Old Cedar Ave S
Bloomington, MN 55425-1207

Mailing address

PO Box 206
Minneapolis, MN 55480-0206
Phone (612) 262-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
15961MNMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684368000000",
    "number": "1588361174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 206",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554800206",
            "telephone_number": "612-262-9000",
            "fax_number": "612-262-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7920 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251207",
            "telephone_number": "952-428-1899",
            "fax_number": "952-428-1723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAY",
        "first_name": "REBECCA",
        "middle_name": "LOUISE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-05-18",
        "certification_date": "2023-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.