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

Individual provider Clinical Social Worker · NPI 1376295436

Ivy Johnson, LICSW is a Clinical Social Worker in Saint Paul, Minnesota. Qualified in 2019, 7 years ago. Practices with Hamm Memorial Psychiatric Clinic, a 13-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
7
Licensed in
MN
In the registry since
2022
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

408 Saint Peter St Ste 429
Saint Paul, MN 55102-1119
Phone: (651) 224-0614
Fax: (651) 224-5754
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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 28148 (MN)

Record details

NPI number1376295436
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedJanuary 20, 2022
Last updated in NPPESJanuary 20, 2022
Certification dateJanuary 20, 2022

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Hamm Memorial Psychiatric Clinic — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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