Individual provider Active NPI

Nicole Michelle Wegner, MSW, LICSW, APSW

  • Clinical Social Worker
  • Duluth, MN
National Provider Identifier
1669296042
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
31001 Issued in MN
Practice address
120 W 2ND St
Duluth, MN 55802-2017
Phone
(218) 728-4491
Fax
(218) 302-8698
NPI assigned
Nov 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 134023 WI
Clinical Social Worker 1041C0700X 31001 MN Primary

Addresses

Primary practice location

120 W 2ND St
Duluth, MN 55802-2017

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Other practice location 1

1401 East 1st Street
Duluth, MN 55805-2407
Phone (218) 728-4491

Other practice location 2

325 11th Ave
Two Harbors, MN 55616-1300
Phone (218) 834-5520

Other practice location 3

810 E 4th St
Duluth, MN 55805-2147
Phone (218) 728-4491

Other practice location 4

40 11th St
Cloquet, MN 55720-1817
Phone (218) 879-4559

Other practice location 5

615 Pecan Ave
Duluth, MN 55811-2749
Phone (218) 355-2100

Other names 1

  • Nicole M Immerfall Other name

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
I20250108000922 MN Practitioner - Clinical Social Worker 4880122639 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Human Development CenterGroup PAC ID 2961485909, 39 clinicians

Practice addresses (Care Compare)

120 W 2ND St
Duluth, MN 55802-2017
Phone (218) 728-4491

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
134023WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
SMDC Medical Center CurrentSince Nov 17, 2025 Accepting new patients
Brightwater Health Dba Human Development Center CurrentSince Jan 1, 2025 Accepting new patients
Brightwater Health Dba Human Development Center PastSince Jan 1, 2025 Accepting new patients
SMDC Medical Center PastSince Nov 17, 2025 Accepting new patients

Locations

40 11th St
Cloquet, MN 55720
Phone (218) 879-4559

120 W 2nd St
Duluth, MN 55802
Phone (218) 728-4491

615 Pecan Ave
Duluth, MN 55811
Phone (218) 355-2100

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

810 E 4th St
Duluth, MN 55805
Phone (218) 728-4491

1401 E 1st St
Duluth, MN 55805
Phone (218) 728-4491

629 1st Ave
Two Harbors, MN 55616
Phone (218) 834-5520

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/humandevelopmentcenter/r4/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1669296042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022017",
            "telephone_number": "218-728-4491",
            "fax_number": "218-302-8698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 East 1st Street",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052407",
            "country_code": "US",
            "telephone_number": "218-728-4491",
            "fax_number": "218-302-8698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 11th Ave",
            "address_purpose": "LOCATION",
            "city": "Two Harbors",
            "state": "MN",
            "postal_code": "556161300",
            "country_code": "US",
            "telephone_number": "218-834-5520",
            "fax_number": "218-834-4264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "810 E 4th St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052147",
            "country_code": "US",
            "telephone_number": "218-728-4491",
            "fax_number": "218-302-8698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "40 11th St",
            "address_purpose": "LOCATION",
            "city": "Cloquet",
            "state": "MN",
            "postal_code": "557201817",
            "country_code": "US",
            "telephone_number": "218-879-4559",
            "fax_number": "218-879-0282",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 Pecan Ave",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558112749",
            "country_code": "US",
            "telephone_number": "218-355-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEGNER",
        "first_name": "NICOLE",
        "middle_name": "MICHELLE",
        "credential": "MSW, LICSW, APSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "134023",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "IMMERFALL",
            "middle_name": "M",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.