Mya Gietzen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

35469 Issued in MN

Practice address

4000 28TH Ave S
Moorhead, MN 56560-7926

Phone

(701) 234-3200

NPI assigned

Feb 21, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  MN

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772496000000",
    "number": "1992561625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 28TH AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565607926",
            "telephone_number": "701-234-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Broadway N",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581023641",
            "country_code": "US",
            "telephone_number": "701-234-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIETZEN",
        "first_name": "MYA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-21",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "6684",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ND",
            "license": "6684",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "35469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Gerardy
• Jolene Germain
• Jacqualine Kay Gervais, PMHNP
• Erianne Siena Gibson, PHARMD
• Desiree Giesen
• Janna M Gilbertson
• Jaurdyn Leeanne Gilliss
• Halle Girtz
• Elizabeth A Gjerde, M.ED
• Kathleen Lynn Glad, MS CCC SLP

• Clinical Social Worker in Moorhead, MN
• Providers in Moorhead, 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 Mar 3, 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.