Old Growth Healing LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

OLD GROWTH HEALING LLC

Practice address

220 Division St S Ste 2
Northfield, MN 55057-2046

Phone

(952) 457-3469

NPI assigned

May 30, 2023

Organization subpart

No

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

Authorized official

Name

Katie JacobiNPI 1164962957

Title

Owner/Psychotherapist

Phone

(952) 457-3469

Specialties & licenses 1

Addresses

Other names 1

• Old Growth Healing Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katie Jacobi

  • Clinical Social Worker
  • Northfield, MN
  • NPI 1164962957

  Clinical, MN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685404800000",
    "number": "1659064293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 DIVISION ST S",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572046",
            "telephone_number": "952-457-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 DIVISION ST S STE 2",
            "city": "NORTHFIELD",
            "state": "MN",
            "postal_code": "550572046",
            "telephone_number": "952-457-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD GROWTH HEALING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A",
        "authorized_official_last_name": "JACOBI",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "952-457-3469"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Growth Healing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northfield Urgent Care LLC
• Nutrition Proportion
• Patrick William O'Neill, O.D.
• Madalyn Sue O'Reilly, OTR/L
• Thomas A Oas, MD
• Oliinc MGMT & Consulting LLC
• Sarah Jo Olin, MOTR/L
• Douglas V Olmanson, MD
• Daniel F Olsen, CRNA
• Jessica Michelle Olson

• All providers in Northfield, MN
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.