Stephanie Hyacinth Tkach, L.I.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

17117 Issued in MN

Practice address

2908 Humboldt Ave S
Suite 6
Minneapolis, MN 55408-1953

Phone

(612) 558-6760

NPI assigned

Sep 13, 2010

Last updated

Jan 24, 2019By the provider in NPPES

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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Range Regional Health ServicesGroup PAC ID 8022920024, 349 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment Care Compare group NPD
• Fairview Express Care

  dba M Health Fairview Recovery Clinic

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment Care Compare group
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Clinics

  dba Fairview Clinics - Integrated Primary Care

  • Clinic/Center
  • Minneapolis, MN
  • NPI 1043516867
  NPD
• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD
• Fairview Health Services

  dba Fairview Emergency Medical Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Range Regional Health Services

  • General Acute Care Hospital
  • Hibbing, MN
  • NPI 1356321699
  NPD
• Range Regional Health Services

  dba HealthLine Medical Supply

  • Durable Medical Equipment & Medical Supplies
  • International Falls, MN
  • NPI 1710954821
  NPD

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1851608749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5752 IRVING AVENUE SOUTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55419",
            "telephone_number": "612-558-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2908 HUMBOLDT AVE S",
            "address_2": "SUITE 6",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554081953",
            "telephone_number": "612-558-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKACH",
        "first_name": "STEPHANIE",
        "middle_name": "HYACINTH",
        "credential": "L.I.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-13",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashly Tammy Toal-Dery, M.D
• Najma Adan Tobe

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, 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 Jan 24, 2019; 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.