Individual provider Active NPI

Destinee Jane Tatro, LICSW

  • Clinical Social Worker
  • Saint Cloud, MN
National Provider Identifier
1851164867
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
30294 Issued in MN
Practice address
1321 13TH St N
Saint Cloud, MN 56303-2613
Phone
(320) 252-5010
NPI assigned
Nov 1, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 30294 MN Primary

Addresses

Primary practice location

1321 13TH St N
Saint Cloud, MN 56303-2613

Mailing address

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20231114001646 MN Practitioner - Clinical Social Worker 5496102329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Minnesota Mental Health CenterGroup PAC ID 4486555877, 23 clinicians

Practice addresses (Care Compare)

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30294MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Central Minnesota Mental Health Center CurrentSince Nov 1, 2023 Accepting new patients
Central Minnesota Mental Health Center CurrentSince Nov 1, 2023 Accepting new patients

Locations

308 12th Ave S
Buffalo, MN 55313
Phone (763) 682-4400

1321 13th St N
Saint Cloud, MN 56303
Phone (320) 252-5010

411 3rd St N
Waite Park, MN 56387
Phone (320) 202-2037

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698796800000",
    "number": "1851164867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010",
            "fax_number": "320-252-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATRO",
        "first_name": "DESTINEE",
        "middle_name": "JANE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-01",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.