Individual provider Active NPI

Kennedy Todd

  • Clinical Social Worker
  • Faribault, MN
National Provider Identifier
1659266849
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
28526 Issued in MN
Practice address
410 Central Ave N
Faribault, MN 55021-5217
Phone
(507) 446-0431
NPI assigned
Jun 10, 2025
Last updated
Jun 10, 2025By the provider in NPPES
Sex
Unspecified or another gender identity
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 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 28526 MN Primary

Addresses

Primary practice location

410 Central Ave N
Faribault, MN 55021-5217

Mailing address

2575 Harvest LN
Owatonna, MN 55060-4305
Phone (507) 446-0431

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
I20250618001115 MN Practitioner - Clinical Social Worker 5395256168 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28526MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fernbrook Family Center, Inc CurrentSince Jun 11, 2025 Accepting new patients
Fernbrook Family Center, Inc PastSince Jun 11, 2025 Accepting new patients
Fernbrook Family Center Past Accepting new patients

Locations

410 Central Ave N
Faribault, MN 55021
Phone (507) 331-3454

2575 Harvest Ln
Owatonna, MN 55060
Phone 5074460431115

Organizations & group practices 3

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": "1749513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1659266849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 HARVEST LN",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550604305",
            "telephone_number": "507-446-0431",
            "fax_number": "507-446-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CENTRAL AVE N",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215217",
            "telephone_number": "507-446-0431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "KENNEDY",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-06-10",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.