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HOLLY DIANE CLARK LICSW
NPI 1649096702
Social Worker - Clinical in Minneapolis, MN

Active since November 22, 2024PECOS Enrolled
4826 CHICAGO AVE STE 105, MINNEAPOLIS, MN 55417(952) 201-5351 Get Directions Write a Review

NPPES record last updated: September 21, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 21, 2025, Nov 22, 2024 (2 updates tracked since 2024).

About Holly Diane Clark Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HOLLY DIANE CLARK LICSW (NPI 1649096702) is an individual clinical provider in Minneapolis, Minnesota, licensed in Minnesota (23348) and active in the NPI registry since November 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1649096702
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameHOLLY DIANE CLARKCredential: LICSW
Location Address4826 CHICAGO AVE STE 105Minneapolis, MN 55417-1055
Mailing Address4826 Chicago Ave Ste 105Minneapolis, MN 55417-1055
Phone(952) 201-5351
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateNovember 22, 2024
Last NPPES UpdateSeptember 21, 20252 updates tracked since enumeration
NPPES CertifiedSeptember 21, 2025
✔ NPI 1649096702 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MN · 23348
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
4826 CHICAGO AVE STE 105, Minneapolis, MN 55417
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Holly Diane Clark Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3072010008
PECOS Enrollment IDI20251007002871
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55417 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $56.00 – $168.28
Typical copayment $0.00 (range $14.00 – $42.07)
Most-billed visit code NA
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MIKAYLA C CLEMENTS LICSW
Social Worker (Clinical)
4826 CHICAGO AVE STE 105
MINNEAPOLIS, MN 55417
Hennepin County (612) 827-3028
MS. JOANNA LYNN JOHNSON LICSW
Social Worker (Clinical)
4826 CHICAGO AVE STE 105
MINNEAPOLIS, MN 55417
Hennepin County (612) 827-3028
LYDIA MAJORS-ROLAND LPCC
Counselor (Professional)
4826 CHICAGO AVE STE 105
MINNEAPOLIS, MN 55417
Hennepin County (612) 827-3028
MS. ALICE BROWN L.I.C.S.W.
Social Worker (Clinical)
4826 CHICAGO AVE STE 105
MINNEAPOLIS, MN 55417
Hennepin County (612) 827-3028
ANTOINETTE SCHUTTA L.P.
Psychologist
4826 CHICAGO AVE STE 105
MINNEAPOLIS, MN 55417
Hennepin County (612) 827-3028

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Holly Clark's NPI number?

The NPI number for Holly Clark is 1649096702. It was assigned to this individual provider in the NPPES registry on November 22, 2024.

Where is Holly Clark located?

Holly Clark practices at 4826 Chicago Ave Ste 105, Minneapolis, MN 55417. The listed phone number is (952) 201-5351.

What is Holly Clark's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Holly Clark enrolled in Medicare?

Yes. Holly Clark is registered in the Medicare PECOS enrollment system.

What insurance does Holly Clark accept?

Health plans from HealthPartners list Holly Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Holly Clark was last updated on September 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.