Individual provider Active NPI

Jessica Marie Coleman

  • Clinical Social Worker
  • St Louis Park, MN
National Provider Identifier
1003118787
Registry record updated Mar 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
26174 Issued in MN
Practice address
1650 W End Blvd Ste 100
St Louis Park, MN 55416-5369
Phone
(763) 331-2161
NPI assigned
Dec 1, 2010
Last updated
Mar 1, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Doula 374J00000X
Clinical Social Worker 1041C0700X 26174 MN Primary

Addresses

Primary practice location

1650 W End Blvd Ste 100
St Louis Park, MN 55416-5369

Mailing address

1650 W End Blvd Ste 100
St Louis Park, MN 55416-5369
Phone (763) 331-2161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251110001736 MN Practitioner - Clinical Social Worker 9335639111 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1650 W End Blvd
Suite 100
St Louis Park, MN 55416-5369

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26174MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Awaken Recovery Counseling Center LLC Clinical CurrentSince Aug 29, 2025 Accepting new patients

Locations

1650 West End Blvd
Ste 100
St Louis Park, MN 55416
Phone (612) 477-5139

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772323200000",
    "number": "1003118787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 W END BLVD STE 100",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165369",
            "telephone_number": "763-331-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 W END BLVD STE 100",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165369",
            "telephone_number": "763-331-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-01",
        "last_updated": "2026-03-01",
        "certification_date": "2026-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "26174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.