Jonathan Walters

Primary specialty

Social WorkerTaxonomy code 104100000X

License

29041 Issued in MN

Practice address

6550 York Ave S Ste 417
Edina, MN 55435-2336

Phone

(952) 426-3034

NPI assigned

Jan 8, 2025

Sex

Male

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

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.

• Mary Mullenbach, PHD, LP, Inc

  • Psychologist
  • Edina, MN
  • NPI 1801182837
  Medicare reassignment NPD

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

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1962212498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2813 VIRGINIA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 YORK AVE S STE 417",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352336",
            "telephone_number": "952-426-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JONATHAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "29041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Waller, LICSW
• Elizabeth Wallis, PA-C
• Laurie Kathryn Walsh, R.N., C.N.P.
• Sabrina Marie Walski-Easton, M.D.
• Erica Anne Walters, CRNA
• Kiel B Walters, L.I.S.C.W.
• Corinne Elizabeth Wambeke, PT
• Emily Wangerin, BS, PTA
• Dena Marie Wanner-Perry, PSY.D., LP
• Warby Parker Inc.

• Social Worker in Edina, MN
• Providers in Edina, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.