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

Kathleen Ann Sullivan, LICSW

Individual provider Clinical Social Worker · NPI 1467574715

Kathleen Ann Sullivan, LICSW is a Clinical Social Worker in Minneapolis, Minnesota. Graduated from Saint Louis University School of Medicine in 1995, 31 years ago. Practices with Lyn-Lake Psychotherapy and Wellness Ltd, a 72-clinician group, works from 2 locations and offers telehealth. Licensed in Minnesota.

Years since qualifying
31
Trained at
Saint Louis University School of Medicine
Licensed in
MN
In the registry since
2007
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

621 W Lake St Ste 350
Minneapolis, MN 55408-2952
Phone: (612) 979-2276
Fax: (612) 925-0427
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3033 Excelsior Blvd Ste 215, Minneapolis, MN 55416-5274 — (612) 293-6523

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 13480 (MN)

Record details

NPI number1467574715
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedApril 6, 2007
Last updated in NPPESOctober 22, 2025
Certification dateOctober 22, 2025

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolSAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 1995 (31 years in practice)
Group practice Lyn-Lake Psychotherapy And Wellness Ltd — 72 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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