Active NPI
Dylan Forrest Woodward, LICSW, LADC
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1669897955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2511
- Practice address
- 300 S 6TH St
Minneapolis, MN 55487-0999 - Phone
- (612) 432-8136
- Fax
- (612) 466-9871
- NPI assigned
- Feb 24, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302674 | MN | |
| Clinical Social Worker | 1041C0700X | 2511 | MN | Primary |
Addresses
Primary practice location
300 S 6TH St
Minneapolis, MN 55487-0999
Mailing address
300 S 6TH St
Minneapolis, MN 55487-0999
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 |
|---|---|---|---|
| 302674 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 2511 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393200000000",
"number": "1669897955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 S 6TH ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554870999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 S 6TH ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554870999",
"telephone_number": "612-432-8136",
"fax_number": "612-466-9871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODWARD",
"first_name": "DYLAN",
"middle_name": "FORREST",
"credential": "LICSW, LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-24",
"last_updated": "2014-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "302674",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "2511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.