JEAN LOUISE FAGERSTROM MSW, LICSW
NPI 1861963118
Social Worker - Clinical in Roseville, MN

Q: What is Jean Fagerstrom's NPI number?

The NPI number for Jean Fagerstrom is 1861963118. It was assigned to this individual provider in the NPPES registry on December 16, 2018.

Q: What is Jean Fagerstrom's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jean Fagerstrom was last updated on December 16, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.

Active since December 16, 2018PECOS Enrolled

2233 HAMLINE AVE N STE 435, ROSEVILLE, MN 55113(612) 440-8535 Get Directions Write a Review

NPPES record last updated: December 16, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Jean Louise Fagerstrom Msw, Licsw NPPES

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

JEAN LOUISE FAGERSTROM MSW, LICSW (NPI 1861963118) is an individual clinical provider in Roseville, Minnesota and active in the NPI registry since December 2018. She is enrolled in Medicare PECOS and is a graduate of University Of Minnesota Medical School (2004).

NPPES Registry Identity

NPI1861963118

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameJEAN LOUISE FAGERSTROMCredential: MSW, LICSW

Location Address2233 HAMLINE AVE N STE 435Roseville, MN 55113-5023

Mailing Address2233 Hamline Ave N Ste 435Roseville, MN 55113-5023 · (612) 440-8535

Phone(612) 440-8535

Sole ProprietorYes

Medical School CMSUniversity Of Minnesota Medical SchoolGraduated 2004

Enumeration DateDecember 16, 2018

✔ NPI 1861963118 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

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.

2233 HAMLINE AVE N STE 435, Roseville, MN 55113

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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)

Jean Louise Fagerstrom Msw, Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9032458070

PECOS Enrollment IDI20190308001161

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 55113 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.

JEAN GREGG LICSW

Social Worker (Clinical)