Active NPI
Tyler Reedy, LICSW
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1780344788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 27195
- Practice address
- 1173 Burr St
Saint Paul, MN 55130-3633 - Phone
- (612) 251-2557
- NPI assigned
- Dec 19, 2021
- Last updated
- Dec 19, 2021
- Sex
- Male
- 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 | 27195 | MN | Primary |
Addresses
Primary practice location
1173 Burr St
Saint Paul, MN 55130-3633
Mailing address
1173 Burr St
Saint Paul, MN 55130-3633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27195 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639872000000",
"number": "1780344788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1173 BURR ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551303633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1173 BURR ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551303633",
"telephone_number": "612-251-2557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REEDY",
"first_name": "TYLER",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-19",
"last_updated": "2021-12-19",
"certification_date": "2021-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "27195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2021; 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.