Unknown Individual – Clinical Social Worker, NPI 1053657833

Unknown Individual is a healthcare provider. based in Cologne, Minnesota. specializing in Clinical Social Worker. They hold a License No. 02425 (MN). The NPI Number for Unknown Individual is 1053657833

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053657833
Phone
(952) 361-9700
Address
107 PAUL AVE N
Deactivation Date
18 September 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6122016654
Graduation Year
1993 (33 years ago)
PAC ID
3779720552
Group Practice PAC ID
5890888556
Professional Enrollment ID
I20130515000296
Data current as of
20 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

  • 107 PAUL AVE N

    COLOGNE, MN 553229330

    Phone: (952) 361-9700

    Mailing address matches the actual address.

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 55322)

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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: 5890888556View full group profile
NameSpecialtyState
Marriage And Family TherapistMN
Marriage And Family TherapistMN
Clinical Social WorkerMN
Clinical PsychologistMN
Marriage And Family TherapistMN
Marriage And Family TherapistMN
Marriage And Family TherapistMN

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1053657833 is assigned to Unknown Individual under the national enumeration system.
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.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Cologne, Minnesota for Unknown Individual based on available NPPES addresses.
What if Cologne, Minnesota seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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