Individual provider Active NPI

Laura Lynn Kirlin, LICSW

  • Clinical Social Worker
  • Park Rapids, MN
National Provider Identifier
1972764454
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
29203 Issued in MN
Practice address
515 Bridge St. East
Park Rapids, MN 56470-1810
Phone
(218) 366-9229
Fax
(218) 237-2520
NPI assigned
Jun 18, 2008
Last updated
Apr 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 29203 MN Primary
Rehabilitation Practitioner 225400000X

Addresses

Primary practice location

515 Bridge St. East
Park Rapids, MN 56470-1810

Mailing address

515 Bridge St. East
P.O. Box 806
Park Rapids, MN 56470-1810
Phone (218) 366-9229

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
I20230214000401 MN Practitioner - Clinical Social Worker 4981076304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lake Country Associates, Inc.Group PAC ID 3779610472, 11 clinicians

Practice addresses (Care Compare)

515 Bridge St
Park Rapids, MN 56470-1210
Phone (218) 366-9229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29203MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Country Associates, Inc. CurrentSince Jan 17, 2023 Accepting new patients
Peterson Medical Clinics, LLC PastSince Jan 17, 2023 Accepting new patients

Locations

515 Bridge St
Park Rapids, MN 56470
Phone (218) 252-0066

Organizations & group practices 2

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": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1972764454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 BRIDGE ST. EAST",
            "address_2": "P.O. BOX 806",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701810",
            "telephone_number": "218-366-9229",
            "fax_number": "218-237-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BRIDGE ST. EAST",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701810",
            "telephone_number": "218-366-9229",
            "fax_number": "218-237-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRLIN",
        "first_name": "LAURA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "29203",
            "primary": true
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Rapids, MN

Sources for this page

Verify at the official NPI Registry.