Tessa Fultz, LICSW
NPI 1568968204ActiveIndividual· Social Worker· Farmington, MN
Social Worker (LICSW) in Farmington, Minnesota, licensed in MN, with an NPI issued in April 2018. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1568968204 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LICSW |
| Sole proprietor | Yes |
| NPI issued | Apr 2, 2018 |
| Last updated in NPPES | Oct 15, 2024 |
| Certified by provider | Oct 15, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker Primary | 104100000X | 26216 | MN |
| Social Worker, Clinical | 1041C0700X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (MN) |
|---|
Education and affiliations
| Graduation year | 2017 |
|---|---|
| Medicare specialty | Clinical Social Worker |
Other Social Worker providers in Farmington
- 1780389189
- 1578266797