Active NPI
Tasha Novotny, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1689326472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 19225
- Practice address
- 1422 W Lake St Ste 206
Minneapolis, MN 55408-2616 - Phone
- (612) 453-3174
- NPI assigned
- Jan 22, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 19225 | MN | Primary |
Addresses
Primary practice location
1422 W Lake St Ste 206
Minneapolis, MN 55408-2616
Mailing address
1422 W Lake St Ste 206
Minneapolis, MN 55408-2616
Phone (612) 453-3174
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 |
|---|---|---|---|
| 19225 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749686400000",
"number": "1689326472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1422 W LAKE ST STE 206",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082616",
"telephone_number": "612-453-3174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1422 W LAKE ST STE 206",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082616",
"telephone_number": "612-453-3174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVOTNY",
"first_name": "TASHA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-22",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "19225",
"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 Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.