Jessica Widboom, MSW, LICSW
NPI 1104785872ActiveIndividual· Social Worker, Clinical· New Brighton, MN
Social Worker, Clinical (MSW, LICSW) in New Brighton, Minnesota, licensed in MN, with an NPI issued in January 2026. Enrolled in Medicare as practitioner - clinical social worker.
Overview
| NPI | 1104785872 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | MSW, LICSW |
| Sole proprietor | No |
| NPI issued | Jan 19, 2026 |
| Last updated in NPPES | Jan 19, 2026 |
| Certified by provider | Jan 19, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 31134 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Social Worker (MN) |
|---|
Education and affiliations
| Graduation year | 2022 |
|---|---|
| Medicare specialty | Clinical Social Worker |
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