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

Shane Russell, LICSW

Individual provider Clinical Social Worker · NPI 1164303046

Shane Russell, LICSW is a Clinical Social Worker in Minneapolis, Minnesota. Licensed in Minnesota. Registered with an NPI since 2025.

Licensed in
MN
In the registry since
2025
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

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone: (612) 273-6440
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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 28620 (MN)

Record details

NPI number1164303046
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedSeptember 9, 2025
Last updated in NPPESOctober 24, 2025
Certification dateSeptember 9, 2025

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