Marybeth Kimball Gage Ehlert, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27432 Issued in MN

Practice address

12301 Whitewater Dr Ste 101
Minnetonka, MN 55343-4157

Phone

(612) 501-6279

NPI assigned

Feb 13, 2020

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

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Sonder Behavioral Health and Wellness IncGroup PAC ID 4880987114, 23 clinicians

Affinity Psychological Services PCGroup PAC ID 0749528552, 66 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.

• Affinity Psychological Services, P.C.

  • Mental Health Counselor
  • Edina, MN
  • NPI 1245610856
  Medicare reassignment Care Compare group NPD
• Sonder Behavioral Health & Wellness, Inc.

  • Clinical Psychologist
  • Minnetonka, MN
  • NPI 1780031732
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1851924245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "952-999-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12301 WHITEWATER DR STE 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553434157",
            "telephone_number": "612-501-6279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHLERT",
        "first_name": "MARYBETH",
        "middle_name": "KIMBALL GAGE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-13",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie Dee Edwards, AGNP-C
• Hannah Egan
• Laura Jean Egan, M.A., CCC-SLP
• Ege Transportation LLC
• Alyssa Egersett, MA, LPCC
• Marian R Eichten, PT
• Mary Elizabeth Einarson, MARY EINARSON, M.A.
• Hailey Eisold
• Eric Eldred
• Elite Anesthesia

• Clinical Social Worker in Minnetonka, MN
• Providers in Minnetonka, 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 Aug 2, 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.