Active NPI
Tera Marie Detels, LGSW
- Social Worker
- Saint Paul, MN
National Provider Identifier
1811807126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 36092
- Practice address
- 539 Phalen Blvd
Saint Paul, MN 55130-5303 - Phone
- (651) 300-9659
- NPI assigned
- Sep 9, 2026
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 36092 | MN | Primary |
Addresses
Primary practice location
539 Phalen Blvd
Saint Paul, MN 55130-5303
Mailing address
539 Phalen Blvd
Saint Paul, MN 55130-5303
Phone (651) 300-9659
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1811807126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "539 PHALEN BLVD",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551305303",
"telephone_number": "651-300-9659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "539 PHALEN BLVD",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551305303",
"telephone_number": "651-300-9659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETELS",
"first_name": "TERA",
"middle_name": "MARIE",
"credential": "LGSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-09",
"last_updated": "2026-09-09",
"certification_date": "2026-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "36092",
"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 Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.