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

Melanie Waller, LICSW

Individual provider Clinical Social Worker · NPI 1962098236

Melanie Waller, LICSW is a Clinical Social Worker in Edina, Minnesota. Qualified in 2019, 7 years ago. Practices with Nystrom and Associates Ltd, a 617-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
7
Licensed in
MN
In the registry since
2020
Specialties on file
2
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

4600 77th St W Ste 370
Edina, MN 55435-4912
Phone: (612) 464-1400
Fax: (612) 315-6001
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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 24772 (MN)
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1962098236
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedDecember 21, 2020
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing address4600 77th St W Ste 370, Edina, MN 55435-4912

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Nystrom And Associates Ltd — 617 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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