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

Jeff William Shively, LICSW

Individual provider Clinical Social Worker · NPI 1376782961

Jeff William Shively, LICSW is a Clinical Social Worker in Plymouth, Minnesota. Licensed in Minnesota. Registered with an NPI since 2009.

Licensed in
MN
In the registry since
2009
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 →

Practice location Address checks out

12805 Highway 55 Ste 200
Plymouth, MN 55441-3859
Phone: (612) 723-0408
Fax: (763) 210-5379
Show map & directions

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

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 18053 (MN)

Record details

NPI number1376782961
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedFebruary 5, 2009
Last updated in NPPESMarch 5, 2013

Other providers in Plymouth