Michelle M Petz, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19774 Issued in MN

Practice address

200 4TH Ave W
Shakopee, MN 55379-1220

Phone

(952) 496-8481

Fax

(952) 496-8535

NPI assigned

Jul 8, 2022

Sex

Female

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

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of ScottGroup PAC ID 4587605225, 11 clinicians

Practice addresses (Care Compare)

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.

• County of Scott

  • Psychologist
  • Shakopee, MN
  • NPI 1841299443

  Single Specialty

  Medicare reassignment Care Compare group NPD
• County of Scott

  • Public Health or Welfare Agency
  • Shakopee, MN
  • NPI 1821156183
  NPD
• Psychotherapy & Healing Associates

  • Psychologist
  • St Louis Park, MN
  • NPI 1801028972
  NPD (past)

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768348800000",
    "number": "1992438774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 JUNE AVE S",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554163537",
            "telephone_number": "651-278-7465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 4TH AVE W",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791220",
            "telephone_number": "952-496-8481",
            "fax_number": "952-496-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZ",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Michelle Peterson, PA-C
• Holly Peterson
• Robert Lynn Peterson, PHD, LP
• Ryan Joseph Petrich, PHARM. D.
• Jennifer Eileen Petrucci Drane, RD, LD
• Phong T Pham, PHARMD
• Sally Phillips
• Angena Phothisane
• Farah Pieper, CRNA
• Suzanne Pierson

• Clinical Social Worker in Shakopee, MN
• Providers in Shakopee, 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 Jan 14, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.