Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1356507578 Deactivated / Inactive NPI Male Practitioner

Michael John Dejong , LICSW

Social Worker - Clinical • Saint Cloud, MN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Michael Dejong has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 07, 2008
NPI Deactivation Date January 17, 2024
Total Practice Duration ~16 Years of Practice (2008 – 2024)

Professional Overview & Biography Verified Profile Summary

Michael Dejong, LICSW was a registered Social Worker - Clinical practicing in Saint Cloud, MN. Throughout an active medical career spanning 16 years, Michael Dejong provided care at the practice location at 22 WILSON AVE NE STE 110 until profile deactivation on 2024-01-17.

Practice Location & Contact Primary Location

Practice Address

22 Wilson Ave Ne Ste 110

Saint Cloud, MN 563040440

Telephone 3202517700
Fax 3202518898
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Social Worker - Clinical in Saint Cloud, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 11.6 Yrs
State Avg: 15.5 Yrs
Regional Practice Density
167 Specialists

Practicing in Saint Cloud, MN (6749 Statewide)

Telehealth Adoption Rate
6.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Social Worker - Clinical Primary Specialty

NUCC Taxonomy Code: 1041C0700X

State License MN 19051

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

16 Associated Practitioners
Gail Anderson , MA, LP

Counselor - Mental Health

NPI 1114024817

Master of Arts, Licensed Psychologist

NPI 1134219165

Master of Arts, Licensed Psychologist

Colleen Davern , LADC LPCC

Counselor - Professional

NPI 1134766470

LADCLPCC

Tara Prom , LICSW

Social Worker - Clinical

NPI 1205338969

Licensed Independent Clinical Social Worker

NPI 1215154133

Doctor of Education (Ed.D.)

Dr. Rose Stark-Rose , PhD

Psychologist - Counseling

NPI 1295039204

Doctor of Philosophy (Ph.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 17, 2024

Record deactivated on January 17, 2024

NPI Profile Active August 07, 2008

NPI status registered as active in NPPES database

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Updated Practice Location August 07, 2008

Registered at 22 WILSON AVE NE STE 110, SAINT CLOUD, MN 563040440 (Tel: 3202517700)

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Updated Business Mailing Address August 07, 2008

Registered at 22 WILSON AVE NE STE 110, SAINT CLOUD, MN 563040440

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Provider Name / Credentials Updated August 07, 2008

Recorded as MICHAEL DEJONG, LICSW

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 07, 2008

Social Worker (License #19051 in MN)

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Initial NPI Registration & Enumeration August 07, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1356507578
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 07, 2008
Last Update: August 07, 2008
Deactivation Date: January 17, 2024

Mailing Address

22 Wilson Ave Ne Ste 110

Saint Cloud, MN 563040440

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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