CASSANDRA LEE KOTNIK (MSW, LICSW) – Clinical Social Worker, NPI 1295200624

CASSANDRA LEE KOTNIK (MSW, LICSW) is a healthcare provider. based in Virginia, Minnesota. specializing in CLINICAL SOCIAL WORKER. They hold the professional credentials MSW, LICSW. They hold a License No. 19965 (MN). The NPI Number for CASSANDRA LEE KOTNIK (MSW, LICSW) is 1295200624

Main info

Female
11 Years Of Experience
Accepts Medicare Assignment
Name
CASSANDRA LEE KOTNIK (MSW, LICSW)
NPI
1295200624
Phone
(218) 749-2881
Address
PO BOX 1188
Enumeration Date
12 October 2018
Last Update Date
12 October 2018

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2187492881
Graduation Year
2015 (11 years ago)
PAC ID
4587918164
Group Practice PAC ID
3173434628
Professional Enrollment ID
I20181117000162
Address ID
MN557923149VI624XXSXXX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:7State licenses:1Digital endpointsOther names

2,310 CLINICAL SOCIAL WORKER in MN

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Provider Addresses for CASSANDRA LEE KOTNIK (MSW, LICSW)

  • Holiday Inn Morgantown - University Area, 1188, Pine View Drive, Tanglewood, Morgantown, Monongalia County, West Virginia, 26505, United States

    VIRGINIA, MN 557921188

    Phone: (218) 749-2881

    Fax: (218) 749-3806

    Type: Mailing

  • 624, 13th Street South, Virginia, Saint Louis County, Minnesota, 55792, United States

    VIRGINIA, MN 557923149

    Phone: (218) 749-2881

    Fax: (218) 749-3806

    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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-11-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20181117000162IClinical Social WorkerMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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 55792)

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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: 3173434628View full group profile
NameSpecialtyState
Mental Health CounselorMN
Clinical Social WorkerMN
Mental Health CounselorMN
-MN
-MN
-MN
Clinical Social WorkerMN
Clinical Social WorkerMN
Nurse PractitionerMN
Nurse PractitionerMN

Reviews

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Frequently asked questions

What is CASSANDRA LEE KOTNIK (MSW, LICSW)'s NPI number?
CASSANDRA LEE KOTNIK (MSW, LICSW)'s NPI is 1295200624 — the number used across U.S. healthcare to identify this provider.
Is there an active status for CASSANDRA LEE KOTNIK (MSW, LICSW)?
For scheduling context, CASSANDRA LEE KOTNIK (MSW, LICSW) is shown as active in the registry.
What kind of doctor is CASSANDRA LEE KOTNIK (MSW, LICSW)?
CASSANDRA LEE KOTNIK (MSW, LICSW) is associated with Clinical Social Worker in the directory — Clinical services aligned with this taxonomy classification.
Is CASSANDRA LEE KOTNIK (MSW, LICSW) located near Virginia?
CASSANDRA LEE KOTNIK (MSW, LICSW) currently maps to Virginia, Minnesota in this extract.
Does CASSANDRA LEE KOTNIK (MSW, LICSW) accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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