Fallyn Joan Nicholson, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27732 Issued in MN

Practice address

624 13TH St S
Virginia, MN 55792-3149

Phone

(218) 749-2881

NPI assigned

May 8, 2025

Last updated

May 8, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Range Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Virginia, MN
  • NPI 1457452823
  Medicare reassignment NPD

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

{
    "created_epoch": "1746662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1720878192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44714 STATE HIGHWAY 65",
            "city": "NASHWAUK",
            "state": "MN",
            "postal_code": "557694464",
            "telephone_number": "218-929-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 13TH ST S",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557923149",
            "telephone_number": "218-749-2881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "FALLYN",
        "middle_name": "JOAN",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-08",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth L Nelson
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• Melvin Dale Newcomb, DDS
• Dao K Nguyen
• Steven Daniel Niece
• Candie L Nikunen
• Michael Asamoah Nkrumah, PHARM D, PA-C
• Kaitlyn Nicolle Bremer Nordling, PA-C
• Northern Diagnostic Services, Inc (North Star Medical Equipment)

• Clinical Social Worker in Virginia, MN
• Providers in Virginia, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.