IndividualActive
D'Undra Willis, LICSW
NPI 1043747926 · Clinical Social Worker · Fridley, MN
D'Undra Willis, LICSW is a Clinical Social Worker provider in Fridley, MN (NPI 1043747926).
Provider details
- NPI number
- 1043747926
- Entity type
- Individual
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Credential
- LICSW
- Sex
- Female
- Sole proprietor
- Yes
- License
- 23648 (MN)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1250 Moore Lake Dr E Ste 205d
Fridley, MN 55432-5176
Phone: (612) 412-4819
Fax: (651) 304-6027
Approximate (ZIP-level) locationGet directions
Mailing address
1250 Moore Lake Dr E Ste 205d
Fridley, MN 55432-5176
Registry dates
- Enumerated
- 2017-05-22
- Last updated
- 2024-11-22
- Certified
- 2024-11-22
Frequently asked questions
- What is D'Undra Willis's NPI number?
- D'Undra Willis's National Provider Identifier (NPI) is 1043747926, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is D'Undra Willis's specialty?
- D'Undra Willis is listed in the NPPES registry with a primary specialty of Clinical Social Worker (Behavioral Health & Social Service Providers).
- Where is D'Undra Willis located?
- D'Undra Willis's practice location on file with NPPES is 1250 Moore Lake Dr E Ste 205d, Fridley, MN 55432-5176.
- What is D'Undra Willis's phone number?
- The practice phone number listed in the NPPES registry for D'Undra Willis is (612) 412-4819.
- Is D'Undra Willis's NPI active?
- Yes — D'Undra Willis's NPI (1043747926) is active in the NPPES registry as of the last update on 2024-11-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.