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

Individual provider Mental Health Counselor · NPI 1194311043

MS. Maia Shanae Jackson, LICSW is a Mental Health Counselor in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2020.

Licensed in
MN
In the registry since
2020
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

1100 Glenwood Ave
Minneapolis, MN 55405-1430
Phone: (612) 871-1454
Fax: (612) 871-1505
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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 29112 (MN)
Mental Health Counselor Taxonomy 101YM0800X

Record details

NPI number1194311043
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedDecember 15, 2020
Last updated in NPPESOctober 13, 2022
Certification dateDecember 15, 2020

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