NPIMap

Organization Active NPI

Mandy Wannarka, Licsw Inc

Doing business as Mindful Wellbeing

  • Clinical Social Worker
  • Coon Rapids, MN
National Provider Identifier
1861038515
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MANDY WANNARKA, LICSW INC
Doing business as
Mindful Wellbeing
Practice address
199 Coon Rapids Blvd NW Ste 208
Coon Rapids, MN 55433-5860
Phone
(612) 440-1899
NPI assigned
Nov 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

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

Authorized official

Name
Amanda Wannarka, LICSW, PMH-CNPI 1841732211
Title
Owner, Psychotherapist
Phone
(612) 309-2691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

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

Mailing address

199 Coon Rapids Blvd NW Ste 208
Coon Rapids, MN 55433-5860
Phone (612) 440-1899

Other names 1

  • Mindful Wellbeing Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230824000341 MN Part B Supplier - Clinic/Group Practice 2860855897 Receives reassigned benefits from 5 practitioners
Practice locations: Coon Rapids, MN

National Provider Directory

National Provider Directory

Locations

2665 4th Ave
Ste 20
Anoka, MN 55303
Phone (612) 481-1198

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1861038515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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",
            "fax_number": "612-500-4499"
        },
        {
            "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": {
        "organization_name": "MANDY WANNARKA, LICSW INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-18",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "WANNARKA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER, PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "612-309-2691",
        "authorized_official_credential": "LICSW, PMH-C"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Wellbeing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mindful Wellbeing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.