Nicole Wellendorf, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23047 Issued in 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

Last updated

Mar 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/wmhcinc/r4/

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.

• CCM Health

  • Critical Access Hospital
  • Montevideo, MN
  • NPI 1720086028
  Medicare reassignment NPD
• Western Mental Health Center, Inc.

  • Mental Health Counselor
  • Marshall, MN
  • NPI 1982613311
  Medicare reassignment NPD
• CCM Health

  • Rural Health Clinic/Center
  • Milan, MN
  • NPI 1457132466
  NPD
• Greater Minnesota Family Services

  • Mental Health Counselor
  • Willmar, MN
  • NPI 1609869726
  NPD (past)

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1831559913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 5TH AVE",
            "city": "GRANITE FALLS",
            "state": "MN",
            "postal_code": "562411502",
            "telephone_number": "320-979-7096",
            "fax_number": "507-218-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 HIGHWAY 212 W STE 7",
            "city": "GRANITE FALLS",
            "state": "MN",
            "postal_code": "562411371",
            "telephone_number": "320-979-7096",
            "fax_number": "507-218-8492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLENDORF",
        "first_name": "NICOLE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-02",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Upper Sioux Community
• Upper Sioux Community Social Services
• Jane Marie Vansickle, PHD, LP
• Bridget Samone Varpness, CNP
• Stephanie Jo Ward
• Yellow Medicine County Family Services
• Yellow Medicine East District 2190

• Clinical Social Worker in Granite Falls, MN
• Providers in Granite Falls, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.