Nicole Wellendorf, LICSW
Individual provider Active NPI Clinical Social Worker · Granite Falls, MN
NPI 1831559913 · NPPES record last updated Mar 30, 2021
Key facts
- NPI
- 1831559913
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 23047 (MN)
- Practice address
- 665 Highway 212 W Ste 7
Granite Falls, MN 56241-1371 - Phone
- (320) 979-7096
- Fax
- (507) 218-8492
- NPI assigned
- Mar 2, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211026003153 | MN | Practitioner - Clinical Social Worker | 8123416047 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CCM Health | Current |
Accepting new patients | |
| Western Mental Health Center, Inc. | Current |
Accepting new patients | |
| CCM Health | Current |
Accepting new patients | |
| Greater Minnesota Family Services | Past |
Accepting new patients |
Locations
1212 E College Dr
Marshall, MN 56258
Phone (507) 532-3236
824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/wmhcinc/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 23047 | MN | Yes |
Addresses
Primary practice location
665 Highway 212 W Ste 7
Granite Falls, MN 56241-1371
Mailing address
140 5TH Ave
Granite Falls, MN 56241-1502
Phone (320) 979-7096
Other providers in Granite Falls, MN
- Upper Sioux Community
- Upper Sioux Community Social Services
- Jane Marie Vansickle
- Bridget Samone Varpness
- Stephanie Jo Ward
- Yellow Medicine County Family Services
- Yellow Medicine East District 2190
All providers in Granite Falls, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.