Active NPI
Kathryn Elison, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1740642214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 23063
- Practice address
- 2512 S 7TH St
Pediatric Specialty Clinic
Minneapolis, MN 55454-1404 - Phone
- (612) 365-6777
- Fax
- (612) 365-8001
- NPI assigned
- Mar 24, 2016
- Sex
- Female
- Sole proprietor
- No
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 | 23063 | MN | Primary |
Addresses
Primary practice location
2512 S 7TH St
Pediatric Specialty Clinic
Minneapolis, MN 55454-1404
Mailing address
717 Delaware St SE
Mail Code 1932
Minneapolis, MN 55414-2959
Phone (704) 707-6681
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458777600000",
"number": "1740642214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 DELAWARE ST SE",
"address_2": "MAIL CODE 1932",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554142959",
"telephone_number": "704-707-6681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2512 S 7TH ST",
"address_2": "PEDIATRIC SPECIALTY CLINIC",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541404",
"telephone_number": "612-365-6777",
"fax_number": "612-365-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELISON",
"first_name": "KATHRYN",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-24",
"last_updated": "2016-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "23063",
"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 Mar 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.