Individual provider Active NPI

Kelly Marie Schultz, LICSW

  • Clinical Social Worker
  • Duluth, MN
National Provider Identifier
1750102919
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
29433 Issued in MN
Practice address
220 N 6TH Ave E
Duluth, MN 55805-1952
Phone
(218) 249-5555
NPI assigned
Oct 21, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 29433 MN Primary

Addresses

Primary practice location

220 N 6TH Ave E
Duluth, MN 55805-1952

Mailing address

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

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
I20241030000375 MN Practitioner - Clinical Social Worker 6709319718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke'S Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

619 W Central Entrance
Duluth, MN 55811-5448
Phone (218) 249-4987

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29433MNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Hospital of Duluth CurrentSince Sep 15, 2024 Accepting new patients
St. Luke'S Hospital of Duluth Current Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Sep 15, 2024 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

220 N 6th Ave E
Duluth, MN 55805
Phone (218) 249-7000

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

619 W Central Entrance
Duluth, MN 55811
Phone (218) 249-4987

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

Organizations & group practices 3

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1729468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1750102919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052107",
            "telephone_number": "218-249-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N 6TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051952",
            "telephone_number": "218-249-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-21",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "220 N 6th Ave E",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558051952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.