Mikayla C Clements, LICSW
Social Worker, Clinical in Minneapolis, MN. Individual provider (NPI-1).
NPI number1013609130
StatusActive
Last updated in NPPESMay 26, 2023
Details
- NPI
- 1013609130
- Entity type
- Individual (NPI-1)
- Name
- Mikayla C Clements
- Credential
- LICSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 25, 2023
- Certification date
- May 26, 2023
- Last updated
- May 26, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 29590 | MN | Yes |
Practice location
4826 Chicago Ave Ste 105Minneapolis, MN 55417-1055
Phone 612-827-3028
Mailing address
4826 Chicago Ave Ste 105Minneapolis, MN 55417-1055
Phone 612-827-3028
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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