Active NPI
Ardella Vandyke, LICSW
- Clinical Social Worker
- Akeley, MN
National Provider Identifier
1619608049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 15683
- Practice address
- 14090 Call of the Wild Dr
Akeley, MN 56433 - Phone
- (763) 412-8319
- NPI assigned
- Jun 17, 2022
- Last updated
- Jun 17, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 15683 | MN | Primary |
Addresses
Primary practice location
14090 Call of the Wild Dr
Akeley, MN 56433
Mailing address
14190 Call of the Wild Dr
Akeley, MN 56433-2606
Phone (673) 412-8319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15683 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655424000000",
"number": "1619608049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14190 CALL OF THE WILD DR",
"city": "AKELEY",
"state": "MN",
"postal_code": "564332606",
"telephone_number": "673-412-8319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14090 CALL OF THE WILD DR",
"city": "AKELEY",
"state": "MN",
"postal_code": "56433",
"telephone_number": "763-412-8319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDYKE",
"first_name": "ARDELLA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-17",
"last_updated": "2022-06-17",
"certification_date": "2022-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "15683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Akeley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.