Active NPI
Michael Damian Wilson, MSW, ACSW, LICSW
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1831536820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 8886
- Practice address
- 345 Smith Ave N
Saint Paul, MN 55102-2346 - Phone
- (651) 220-6436
- NPI assigned
- May 30, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 8886 | MN | Primary |
Addresses
Primary practice location
345 Smith Ave N
Saint Paul, MN 55102-2346
Mailing address
2910 Centre Pointe Dr
35-121A
Roseville, MN 55113-1182
Phone (651) 855-2109
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
| License | State | Type | Specialty |
|---|---|---|---|
| 8886 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369872000000",
"number": "1831536820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2910 CENTRE POINTE DR",
"address_2": "35-121A",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551131182",
"telephone_number": "651-855-2109",
"fax_number": "651-855-2310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 SMITH AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022346",
"telephone_number": "651-220-6436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHAEL",
"middle_name": "DAMIAN",
"name_prefix": "Mr.",
"credential": "MSW, ACSW, LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-30",
"last_updated": "2013-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "8886",
"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 May 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.