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

Jeffrey Scott Widner, LICSW

Individual provider Clinical Social Worker · NPI 1114668829

Jeffrey Scott Widner, LICSW is a Clinical Social Worker in Bemidji, Minnesota. Qualified in 2020, 6 years ago. Practices with I Am Incorporated, a 2-clinician group. Licensed in Minnesota and Wisconsin.

Years since qualifying
6
Licensed in
MN, WI
In the registry since
2022
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

403 4th St NW Ste 115
Bemidji, MN 56601-3155
Phone: (218) 214-9389
Fax: (218) 517-2034
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 29410 (MN)
Clinical Social Worker Taxonomy 1041C0700X · Licence 11755-123 (WI)

Record details

NPI number1114668829
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedApril 5, 2022
Last updated in NPPESMay 31, 2024
Certification dateMay 31, 2024
Mailing address403 4th St Nw Ste 115, Bemidji, MN 56601-3155

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice I Am Incorporated — 2 clinicians
Accepts Medicare assignment Not indicated

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