Individual provider Active NPI

Crystal Wimpfheimer, LICSW

  • Clinical Social Worker
  • Elk River, MN
National Provider Identifier
1962386284
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21445 Issued in MN
Practice address
400 Jackson Ave NW
Elk River, MN 55330-3926
Phone
(763) 308-5081
NPI assigned
Jul 31, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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 21445 MN Primary

Addresses

Primary practice location

400 Jackson Ave NW
Elk River, MN 55330-3926

Mailing address

13182 Ranch Rd NW
Elk River, MN 55330-8709
Phone (763) 291-7260

Other names 1

  • Crystal Larson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21445MNMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1753920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1962386284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13182 RANCH RD NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308709",
            "telephone_number": "763-291-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 JACKSON AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553303926",
            "telephone_number": "763-308-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMPFHEIMER",
        "first_name": "CRYSTAL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-31",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "21445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "LARSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elk River, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.