1. Home
  2. Directory
  3. Minnesota
  4. New Brighton
  5. Social Worker
  6. NPI Profile

JESSICA WIDBOOM MSW, LICSW
NPI 1104785872
Social Worker - Clinical in New Brighton, MN

Active since January 19, 2026PECOS Enrolled
900 LONG LAKE RD STE 360, NEW BRIGHTON, MN 55112(612) 900-0233 Get Directions Write a Review

NPPES record last updated: January 19, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jessica Widboom Msw, Licsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA WIDBOOM MSW, LICSW (NPI 1104785872) is an individual clinical provider in New Brighton, Minnesota, licensed in Minnesota (31134) and active in the NPI registry since January 2026. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1104785872
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJESSICA WIDBOOMCredential: MSW, LICSW
Location Address900 LONG LAKE RD STE 360New Brighton, MN 55112-6428
Mailing Address900 Long Lake Rd Ste 360New Brighton, MN 55112-6428
Phone(612) 900-0233
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateJanuary 19, 2026
NPPES CertifiedJanuary 19, 2026
✔ NPI 1104785872 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MN · 31134
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
900 LONG LAKE RD STE 360, New Brighton, MN 55112
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Widboom Msw, Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3173004918
PECOS Enrollment IDI20260219004261
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55112 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $56.00 – $168.28
Typical copayment $0.00 (range $14.00 – $42.07)
Most-billed visit code NA
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CORBIN CASALENDA LICSW
Social Worker (Clinical)
900 LONG LAKE RD STE 360
NEW BRIGHTON, MN 55112
Ramsey County (612) 900-0233

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Widboom's NPI number?

The NPI number for Jessica Widboom is 1104785872. It was assigned to this individual provider in the NPPES registry on January 19, 2026.

Where is Jessica Widboom located?

Jessica Widboom practices at 900 Long Lake Rd Ste 360, New Brighton, MN 55112. The listed phone number is (612) 900-0233.

What is Jessica Widboom's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jessica Widboom enrolled in Medicare?

Yes. Jessica Widboom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jessica Widboom was last updated on January 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.