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

Melissa Grace Bennett, LICSW

Individual provider Clinical Social Worker · NPI 1104690163

Melissa Grace Bennett, LICSW is a Clinical Social Worker in Maple Grove, Minnesota. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in Minnesota.

Years since qualifying
3
Licensed in
MN
In the registry since
2023
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

11671 Fountains Dr N Ste 200
Maple Grove, MN 55369-4784
Phone: (612) 223-8898
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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 33168 (MN)

Record details

NPI number1104690163
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorYes
NPI enumeratedNovember 9, 2023
Last updated in NPPESMay 20, 2026
Certification dateMay 20, 2026
Mailing address11671 Fountains Dr N Ste 200, Maple Grove, MN 55369-4784

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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