Space to Be LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SPACE TO BE LLC

Practice address

2601 Humboldt Ave N
Minneapolis, MN 55411-2041

Phone

(612) 644-8390

NPI assigned

Jul 2, 2026

Organization subpart

No

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

Authorized official

Name

Ms. Maia Shanae Jackson, MSW, LICSWNPI 1194311043

Title

Psychotherapist

Phone

(612) 644-8390

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maia Shanae Jackson, LICSW

  • Clinical Social Worker
  • Minneapolis, MN
  • NPI 1194311043
  NPD (past) Authorized official

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

{
    "created_epoch": "1782950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782950400000",
    "number": "1689591273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 HUMBOLDT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 HUMBOLDT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112041",
            "telephone_number": "612-644-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE TO BE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-02",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MAIA",
        "authorized_official_middle_name": "SHANAE",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "612-644-8390",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aisha Sow
• Augusta N Sowa
• Patrick Alahagi Sowah
• Laura Sower, PHARMD
• Esra Soylu Ozturk, MD
• Jennifer Spadgenske, PHARMD
• Kevin Robert Spahr, DPT
• Emilia Rose Spalding, RN
• Joel P Spalding, MD
• Nick Romaine Spanel, D.D.S.

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, 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 Jul 2, 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.