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

Individual provider Clinical Social Worker · NPI 1417223371

Kelly M Nelson, LICSW is a Clinical Social Worker in Minnetonka, Minnesota. Qualified in 2006, 20 years ago. Practices with Doctor on Demand Professionals P C, a 127-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
20
Licensed in
MN
In the registry since
2012
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

11708 Wayzata Blvd
Minnetonka, MN 55305-2014
Phone: (952) 544-0964
Fax: (952) 544-6405
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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 19801 (MN)

Record details

NPI number1417223371
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedMarch 26, 2012
Last updated in NPPESMarch 26, 2012

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Doctor On Demand Professionals P C — 127 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Minnetonka