Holly Diane Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23348 Issued in MN

Practice address

4826 Chicago Ave Ste 105
Minneapolis, MN 55417-1055

Phone

(952) 201-5351

NPI assigned

Nov 22, 2024

Last updated

Sep 21, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Unrooted Counseling LLC

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1700604931
  Medicare reassignment NPD
• Center for Child Abuse Prevention and Treatment

  dba Family Enhancement Center

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1427228709
  NPD (past)

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

{
    "created_epoch": "1732233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758412800000",
    "number": "1649096702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4826 CHICAGO AVE STE 105",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4826 CHICAGO AVE STE 105",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554171055",
            "telephone_number": "952-201-5351"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Washington Ave N Ste 406",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554011370",
            "country_code": "US",
            "telephone_number": "971-220-2127",
            "fax_number": "844-605-1865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "HOLLY",
        "middle_name": "DIANE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-22",
        "last_updated": "2025-09-21",
        "certification_date": "2025-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Clark, RN
• Devin Clark, MD
• Emily Clark, L.AC., MSTOM
• Emily Clark
• Hailey Mae Clark, RN, BSN, CHPN, PHN
• Howard Brent Clark, M.D.
• Jennifer Clark
• Jennifer Anna Clark, RD, LD
• John Louis Clark, MD
• Mary Watson Clark, LICSW, LMSW

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.