Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tomas John Wildenborg, LICSW

Individual provider Clinical Social Worker · NPI 1023395282

Tomas John Wildenborg, LICSW is a Clinical Social Worker in Minneapolis, Minnesota. Qualified in 2013, 13 years ago. Practices with Fraser Child and Family Center, a 55-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
13
Licensed in
MN
In the registry since
2011
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

2400 W 64th St
Minneapolis, MN 55423-1001
Phone: (612) 861-1688
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 25741 (MN)

Record details

NPI number1023395282
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedNovember 15, 2011
Last updated in NPPESApril 15, 2021
Certification dateApril 13, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Fraser Child And Family Center — 55 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Colleagues at Fraser Child and Family Center

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 55 clinicians in the practice; 12 are shown here.

Other providers in Minneapolis