Amanda Wannarka, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23382 Issued in MN

Practice address

199 Coon Rapids Blvd NW Ste 208
Coon Rapids, MN 55433-5860

Phone

(612) 440-1899

NPI assigned

Nov 16, 2016

Sex

Female

Sole proprietor

Yes

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

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mandy Wannarka Licsw IncGroup PAC ID 2860855897, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mandy Wannarka, Licsw Inc

  • Clinical Social Worker
  • Coon Rapids, MN
  • NPI 1861038515
  Medicare reassignment Care Compare group NPD Authorized official
• Psychotherapy & Healing Associates

  • Psychologist
  • St Louis Park, MN
  • NPI 1801028972
  NPD (past)

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1841732211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2906 129TH AVE NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482384",
            "telephone_number": "612-309-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 COON RAPIDS BLVD NW STE 208",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335860",
            "telephone_number": "612-440-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNARKA",
        "first_name": "AMANDA",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Rae Walvatne, N.P.
• Brianna Walvoort, PT, DPT
• Andrew John Wandersee, CRNA
• Richard Alan Wandersee, MSW LICSW
• George Randall Wandling Jr., MD
• Samantha Jeanne Wanner
• Paula Wardour, OTR/L
• Josslyn Warneke
• Randall C Warren, MD
• Mary Theresa Watson, WHCNP

• Clinical Social Worker in Coon Rapids, MN
• Providers in Coon Rapids, 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 Nov 3, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.