Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Charles Westholm, LICSW

Individual provider Clinical Social Worker · NPI 1770454050

Charles Westholm, LICSW is a Clinical Social Worker in Minnetonka, Minnesota. Qualified in 2022, 4 years ago. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2025
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

5125 County Road 101 Ste 300
Minnetonka, MN 55345-4157
Phone: (952) 932-7277
Fax: (952) 932-9827
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 31231 (MN)

Record details

NPI number1770454050
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedSeptember 17, 2025
Last updated in NPPESSeptember 17, 2025
Certification dateSeptember 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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