Ingersoll Associates LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

01313 Issued in MN

Legal business name

INGERSOLL ASSOCIATES LLC

Practice address

5522 W Bald Eagle Blvd
White Bear Lake, MN 55110-6412

Phone

(651) 429-0838

NPI assigned

Dec 18, 2006

Organization subpart

No

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

Authorized official

Name

Mina Ingersol, LICSW

Title

Owner

Phone

(651) 429-0838

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416787200000",
    "number": "1841353232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5522 W BALD EAGLE BLVD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551106412",
            "telephone_number": "651-429-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5522 W BALD EAGLE BLVD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551106412",
            "telephone_number": "651-429-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGERSOLL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2014-11-24",
        "status": "A",
        "authorized_official_last_name": "INGERSOL",
        "authorized_official_first_name": "MINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-429-0838",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "01313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220058900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "56088DR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.