Individual provider Active NPI

Kari Leah Vacinek, M.S.W., L.I.C.S.W

  • Clinical Social Worker
  • Chanhassen, MN
National Provider Identifier
1790127199
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
19931 Issued in MN
Practice address
600 W 78TH St Ste 10
Chanhassen, MN 55317-2601
Phone
(952) 405-9369
NPI assigned
Jul 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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 19931 MN Primary

Addresses

Primary practice location

600 W 78TH St Ste 10
Chanhassen, MN 55317-2601

Mailing address

680 Dresden Dr
Chaska, MN 55318-1478
Phone (952) 405-9369

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
I20150504000560 MN Practitioner - Clinical Social Worker 0941529549 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19931MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling and Therapeutic Support Services PLLC CurrentSince Aug 15, 2020 Accepting new patients

Locations

600 W 78th St
Ste 10
Chanhassen, MN 55317
Phone (952) 405-9369

600 W 78th St
Ste 10I
Chanhassen, MN 55317
Phone (612) 702-1976

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1374710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591315200000",
    "number": "1790127199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 DRESDEN DR",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181478",
            "telephone_number": "952-405-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W 78TH ST STE 10",
            "city": "CHANHASSEN",
            "state": "MN",
            "postal_code": "553172601",
            "telephone_number": "952-405-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACINEK",
        "first_name": "KARI",
        "middle_name": "LEAH",
        "credential": "M.S.W., L.I.C.S.W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-25",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chanhassen, MN

Sources for this page

Verify at the official NPI Registry.