Melanie Waller, LICSW
Social Worker, Clinical in Edina, MN. Individual provider (NPI-1).
NPI number1962098236
StatusActive
Last updated in NPPESNov 3, 2026
Details
- NPI
- 1962098236
- Entity type
- Individual (NPI-1)
- Name
- Melanie Waller
- Credential
- LICSW
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 21, 2020
- Certification date
- Nov 3, 2026
- Last updated
- Nov 3, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CLINICAL SOCIAL WORKER
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- 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 | 24772 | MN | Yes |
| 101YM0800X | Counselor, Mental Health | – | – |
Practice location
4600 77th St W Ste 315Edina, MN 55435-4909
Phone 763-237-5490 · Fax 612-315-6001
Mailing address
4600 77th St W Ste 370Edina, MN 55435-4912
Phone 612-464-1400 · Fax 612-315-6001
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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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