Individual provider Active NPI

Kristin Elizabeth Gloe-Thordin, MSW, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1790109155
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
20981 Issued in MN
Practice address
771 Raymond Ave
Saint Paul, MN 55114-1522
Phone
(612) 235-6743
Fax
(612) 524-5527
NPI assigned
Feb 5, 2014
Last updated
Jan 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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 20981 MN Primary

Addresses

Primary practice location

771 Raymond Ave
Saint Paul, MN 55114-1522

Mailing address

771 Raymond Ave
Saint Paul, MN 55114-1522
Phone (612) 235-6743

Other practice location 1

3333 University Ave SE
Minneapolis, MN 55414-3325
Phone (612) 728-5399 ext. 5552

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

LicenseStateTypeSpecialty
20981MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kristin Gloe-Thordin Therapy Clinical Current Accepting new patients
Oliver Ross Psychology and Consulting LLC CurrentSince Jun 30, 2024 Accepting new patients
Reclaim Clinical CurrentSince Jan 10, 2021 Accepting new patients
Fraser Past Accepting new patients
Fraser Child and Family Center PastSince Dec 11, 2020 Accepting new patients

Locations

771 Raymond Ave
Saint Paul, MN 55114
Phone (612) 235-6743

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1790109155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 RAYMOND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141522",
            "telephone_number": "612-235-6743",
            "fax_number": "612-524-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 RAYMOND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141522",
            "telephone_number": "612-235-6743",
            "fax_number": "612-524-5527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 University Ave SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554143325",
            "country_code": "US",
            "telephone_number": "612-728-5399 x5552",
            "fax_number": "612-728-5301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLOE-THORDIN",
        "first_name": "KRISTIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-05",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "20981",
            "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 Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.