TESSA FULTZ LICSW NPI 1568968204

NPI Information

  • NPI: 1568968204
  • Provider Name: TESSA FULTZ, LICSW
  • Classification: Social Worker - 104100000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 408 3RD ST STE 107
    FARMINGTON, MN
    ZIP 55024
  • Phone: (651) 252-4025

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NPI Details

Tessa Fultz, LICSW is a social worker in Farmington, MN. The provider is a social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. Tessa Fultz, LICSW NPI is 1568968204. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

408 3RD ST STE 107
FARMINGTON, MN
ZIP 55024-355
Phone: (651) 252-4025
Fax: (651) 390-6136

The NPI 1568968204 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 4/2/2018 and was last updated on 10/15/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11041C0700XSocial WorkerClinicalNo
2104100000XSocial Worker26216MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11780389189OTHERMINNESOTANPI 2

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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