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

Individual provider Clinical Social Worker · NPI 1104785872

Jessica Widboom, MSW, LICSW is a Clinical Social Worker in New Brighton, Minnesota. Qualified in 2022, 4 years ago. Licensed in Minnesota.

Years since qualifying
4
Licensed in
MN
In the registry since
2026
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.
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

900 Long Lake Rd Ste 360
New Brighton, MN 55112-6428
Phone: (612) 900-0233
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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 31134 (MN)

Record details

NPI number1104785872
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSW , LICSW
Sole proprietorNo
NPI enumeratedJanuary 19, 2026
Last updated in NPPESJanuary 19, 2026
Certification dateJanuary 19, 2026

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in New Brighton