Jessica Widboom, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

31134 Issued in MN

Practice address

900 Long Lake Rd Ste 360
New Brighton, MN 55112-6428

Phone

(612) 900-0233

NPI assigned

Jan 19, 2026

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Conscious Healing Counseling Inc

  • Mental Health Counselor
  • Andover, MN
  • NPI 1366944597
  Medicare reassignment NPD

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

{
    "created_epoch": "1768780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768780800000",
    "number": "1104785872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD STE 360",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LONG LAKE RD STE 360",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551126428",
            "telephone_number": "612-900-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDBOOM",
        "first_name": "JESSICA",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-19",
        "last_updated": "2026-01-19",
        "certification_date": "2026-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "31134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn Allen Werner, MS, LP
• Grayson T West, D.D.S.
• Taylor Kay West, MS, LPCC
• Janet Westlund, LICSW
• Hasmin Wicklund Najm
• Jennifer Lynn Wiitala, PTA
• Dena Elaine Williams
• Nichole Lyn Williams
• Willow Home Care Inc
• Willow Home Care Inc

• Clinical Social Worker in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.