Jeff Shively, MSW, Licsw

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18053 Issued in MN

Legal business name

JEFF SHIVELY, MSW, LICSW

Practice address

8120 Penn Ave S Ste 500E
Bloomington, MN 55431-1367

Phone

(612) 723-0408

NPI assigned

Aug 2, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jeff W Shively, LICSW

Title

President

Phone

(612) 723-0408

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785888000000",
    "number": "1366874299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8120 PENN AVE S STE 500E",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311367",
            "telephone_number": "612-723-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 PENN AVE S STE 500E",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311367",
            "telephone_number": "612-723-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFF SHIVELY, MSW, LICSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-02",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "SHIVELY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-723-0408",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "18053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aiyzah Mansur Javaid, DDS
• Dustin James Javers, PT
• JBC Services PLLC
• Khalid Jedal
• Robert J Jeddeloh, M.D.
• Lilli Ann Jeffrey-Smith, PH.D.
• Anastasia Jellison
• Dorothy Lee Jenicke, STUDENT
• Jacob Ray Jenness, OD
• Amy Jo Jensen, OTR

• Clinical Social Worker in Bloomington, MN
• Providers in Bloomington, 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 Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.