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

Individual provider Clinical Social Worker · NPI 1326838665

Justin Potter, LICSW is a Clinical Social Worker in Bloomington, Minnesota. Qualified in 2015, 11 years ago. Practices with Nystrom and Associates Ltd, a 617-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
11
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

1101 E 78th St Ste 100
Bloomington, MN 55420-1402
Phone: (952) 854-5034
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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 24510 (MN)

Record details

NPI number1326838665
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorYes
NPI enumeratedMay 9, 2025
Last updated in NPPESMay 9, 2025
Certification dateMay 9, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Nystrom And Associates Ltd — 617 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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