Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kris Mallon Hennelly, MSW, LICSW

Individual provider Clinical Social Worker · NPI 1417031824

Kris Mallon Hennelly, MSW, LICSW is a Clinical Social Worker in Minneapolis, Minnesota. Qualified in 2000, 26 years ago. Practices with Associated Clinic of Psychology Inc, a 137-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
26
Licensed in
MN
In the registry since
2006
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.
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

4027 County Road 25
Minneapolis, MN 55416-2629
Phone: (612) 925-6033
Fax: (612) 925-8496
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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 17387 (MN)

Record details

NPI number1417031824
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSW , LICSW
Sole proprietorNo
NPI enumeratedOctober 24, 2006
Last updated in NPPESMay 22, 2026
Certification dateMay 22, 2026

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Associated Clinic Of Psychology Inc — 137 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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