Casey J Petek, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

25034 Issued in MN

Practice address

507 22ND Ave E Ste 1
Alexandria, MN 56308-5186

Phone

(320) 762-5124

Fax

(320) 762-2422

NPI assigned

Apr 20, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

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.

• Lutheran Social Service of Minnesota

  • Community/Behavioral Health Agency
  • Saint Cloud, MN
  • NPI 1629192430
  Medicare reassignment NPD

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1962083964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 22ND AVE E STE 1",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085186",
            "telephone_number": "320-762-5124",
            "fax_number": "320-762-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 22ND AVE E STE 1",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563085186",
            "telephone_number": "320-762-5124",
            "fax_number": "320-762-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETEK",
        "first_name": "CASEY",
        "middle_name": "J",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "casey.petek@lssmn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "emr",
            "address_1": "507 22nd Ave E Ste 1",
            "city": "Alexandria",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563085186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carly Pederson
• Kaitlyn Marie Pederson
• Kristine J Pederson, PA-C
• Kayla Perrier
• Abbie Perry
• Thyra Peterick
• Ashlyn Kay Peterson, PA
• David Hedden Peterson, LICSW
• Janeen M Peterson, RD
• Matthew Jon Peterson, MD

• Clinical Social Worker in Alexandria, MN
• Providers in Alexandria, 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 Apr 20, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.