Individual provider Active NPI

Cassidy Christine Gilman, LICSW

  • Clinical Social Worker
  • Maple Grove, MN
National Provider Identifier
1902688237
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27887 Issued in MN
Practice address
12720 Bass Lake Rd
Maple Grove, MN 55369-6307
Phone
(763) 278-0832
NPI assigned
Oct 20, 2023
Last updated
Nov 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 27887 MN Primary

Addresses

Primary practice location

12720 Bass Lake Rd
Maple Grove, MN 55369-6307

Mailing address

700 Rucks Farm Rd
Delano, MN 55328-8733

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240304001142 MN Practitioner - Clinical Social Worker 2062857774 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27887MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Clinic Network CurrentSince Jan 7, 2024 Accepting new patients
Children's Clinic Network CurrentSince Jan 7, 2024 Accepting new patients
Childrens Health Care CurrentSince Nov 27, 2024 Accepting new patients
Childrens Health Care CurrentSince Nov 27, 2024 Accepting new patients
Childrens Health Care Current Accepting new patients

Locations

12720 Bass Lake Rd
Maple Grove, MN 55369
Phone (763) 278-0804

2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691

347 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-6000

1547 Livingston Ave
West St Paul, MN 55118
Phone (651) 451-8050

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1902688237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 RUCKS FARM RD",
            "city": "DELANO",
            "state": "MN",
            "postal_code": "553288733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-278-0832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMAN",
        "first_name": "CASSIDY",
        "middle_name": "CHRISTINE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-20",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.