Jean Louise Fagerstrom, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2233 Hamline Ave N Ste 435
Roseville, MN 55113-5023

Phone

(612) 440-8535

NPI assigned

Dec 16, 2018

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

University of Minnesota Medical School, 2004

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Nathan and Associates LLCGroup PAC ID 3274890140, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Nathan & Associates, LLC

  • Clinical Social Worker
  • Roseville, MN
  • NPI 1982123345

  Clinical, MN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544918400000",
    "number": "1861963118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 HAMLINE AVE N STE 435",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551135023",
            "telephone_number": "612-440-8535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 HAMLINE AVE N STE 435",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551135023",
            "telephone_number": "612-440-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGERSTROM",
        "first_name": "JEAN",
        "middle_name": "LOUISE",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anton Dante Evans, LMFT
• Trevor Lee Everett, M.D.
• Expressive Minds, LLC
• Extendicare Homes, Inc.
• Facial Pain Center PLLC
• Faithfully Massage & Bodywork, LLC
• Lauren Falk, PT, DPT, ATC, CSCS
• Kecia K Farley, FNP-C
• John David Farr, PT
• Jessica Faruq, M.A.

• Clinical Social Worker in Roseville, MN
• Providers in Roseville, 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 Dec 16, 2018; 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.