Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Fallyn Joan Nicholson, MSW, LICSW

Individual provider Clinical Social Worker · NPI 1720878192

Fallyn Joan Nicholson, MSW, LICSW is a Clinical Social Worker in Virginia, Minnesota. Qualified in 2022, 4 years ago. Practices with Range Mental Health Center, an 18-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2025
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.
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

624 13th St S
Virginia, MN 55792-3149
Phone: (218) 749-2881
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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 27732 (MN)

Record details

NPI number1720878192
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSW , LICSW
Sole proprietorNo
NPI enumeratedMay 8, 2025
Last updated in NPPESMay 8, 2025
Certification dateMay 8, 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)
Group practice Range Mental Health Center — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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