Kelly Hildre, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

15 2ND St NW
Buffalo, MN 55313-1357

Phone

(763) 612-2097

NPI assigned

Feb 24, 2023

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, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Jacqui Ruzicka Counseling Services LLCGroup PAC ID 9133462161, 2 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.

• Jacqui Ruzicka Counseling Services, LLC

  • Community/Behavioral Health Agency
  • Hutchinson, MN
  • NPI 1669849808
  Medicare reassignment Care Compare group NPD
• True Balance LTD

  • Multi-Specialty Clinic/Center
  • Little Falls, MN
  • NPI 1205025442

  Clinical

  NPD (past)

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

{
    "created_epoch": "1677196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1871292284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 4TH AVE NW",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 2ND ST NW",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131357",
            "telephone_number": "763-612-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILDRE",
        "first_name": "KELLY",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-24",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron John Hendrickson, DC
• Kara Marie Hendrickson, MA CF-SLP
• Melissa Rae Hendrickson, RD, LD
• Edward Henk, DDS
• Caitlin McClung Hiemenz, M.S. SLP
• Ashlin Hodgson, CCC-SLP
• Lorraine Hoffman, LP
• Matthew Hoffman, M.D.
• Kathleen Holmes
• Hope-Filled Hearts

• Clinical Social Worker in Buffalo, MN
• Providers in Buffalo, 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 Feb 24, 2023; 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.