Unknown Individual – Clinical Social Worker, NPI 1013130509

Unknown Individual is a healthcare provider. based in Maplewood, Minnesota. specializing in Clinical Social Worker. They hold a License No. 11057 (MN). The NPI Number for Unknown Individual is 1013130509

Main info

Organization
Inactive
22 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013130509
Phone
(651) 254-4793
Address
2345 Ariel St N
Deactivation Date
10 September 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6514391234
Graduation Year
2004 (22 years ago)
PAC ID
9335407857
Group Practice PAC ID
1759293954
Professional Enrollment ID
I20171211000980
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 2345 Ariel St N

    Maplewood, MN 551092248

    Phone: (651) 254-4793

    Type: Location

  • 8170 33RD AVE S # MS 21110Q

    MINNEAPOLIS, MN 554254516

    Phone: (651) 439-1234

    Type: Mailing

  • 2345 ARIEL ST N

    MAPLEWOOD, MN 55109

    Phone: (651) 254-4793

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55109)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1759293954View full group profile
NameSpecialtyState
-MN
Clinical PsychologistMN
-MN
P S Y C H I A T R YMN
Family PracticeMN
-MN
P O D I A T R YMN
Physician AssistantMN
Physician AssistantMN
D E R M A T O L O G YMN

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1013130509 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Maplewood, Minnesota for Unknown Individual; expand the address list for detail.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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