Kaila Formanek, LGSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

410 Church St SE
Minneapolis, MN 55455-0222

Phone

(612) 625-8400

NPI assigned

Nov 21, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1982313730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 CHURCH ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550222",
            "telephone_number": "612-625-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 CHURCH ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550222",
            "telephone_number": "612-625-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMANEK",
        "first_name": "KAILA",
        "credential": "LGSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-21",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013137355",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "forma035@umn.edu",
            "affiliation": "N",
            "address_1": "410 Church St SE",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554550222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susan Koelz Ford, PT
• Forefront Dermatology, S.C.
• Joanna Forga, RN
• Billie Edward Forisha, PH.D.
• Michael William Forkey, RN, GNP
• Formless Form Qigong & Acupuncture
• Hannah Marcella Forrest, RN
• Meghan Forrest, DIPL.AC, LAC
• Frances Jeanne Forse
• Margaret Forse

• Mental Health Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.