Individual provider · Type 1 NPI

Melanie Waller, LICSW

Clinical Social Worker · Edina, MN

NPI number 1962098236 Active

Practice location

4600 77th St W Ste 370
Edina, MN 55435-4912

Fax (612) 315-6001

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700X24772 (MN)
Mental Health Counselor 101YM0800XNone listed

Clinical Social Worker: 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 interpers…

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About NPI 1962098236

Melanie Waller, LICSW's National Provider Identifier is 1962098236, issued on Dec 21, 2020. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Edina, MN. The record was last updated on Apr 20, 2026.