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

Jody Wallin, LICSW

Individual provider Clinical Social Worker · NPI 1124449392

Jody Wallin, LICSW is a Clinical Social Worker in Maple Grove, Minnesota. Licensed in Minnesota. Registered with an NPI since 2013.

Licensed in
MN
In the registry since
2013
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

12915 63rd Ave N
Maple Grove, MN 55369-6001
Phone: (952) 826-8465
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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 20641 (MN)

Record details

NPI number1124449392
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedDecember 13, 2013
Last updated in NPPESDecember 13, 2013
Mailing address12915 63rd Ave N, Maple Grove, MN 55369-6001

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