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JESSICA ELIZABETH HOLLY LICSW
NPI 1457636615
Social Worker - Clinical in Minneapolis, MN

Active since October 19, 2011Opted out of Medicare · through Apr 1, 2028
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405(612) 871-1454(612) 871-1505 Get Directions Write a Review

NPPES record last updated: December 3, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jessica Elizabeth Holly Licsw NPPES

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

JESSICA ELIZABETH HOLLY LICSW (NPI 1457636615) is an individual clinical provider in Minneapolis, Minnesota, licensed in Minnesota (19721) and active in the NPI registry since October 2011. She has opted out of Medicare through April 1, 2028.

NPPES Registry Identity

NPI1457636615
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameJESSICA ELIZABETH HOLLYCredential: LICSW
Location Address1100 GLENWOOD AVEMinneapolis, MN 55405-1430
Mailing Address1100 Glenwood AveMinneapolis, MN 55405-1430 · (612) 871-1454 · Fax (612) 871-1505
Phone(612) 871-1454
Fax(612) 871-1505
Sole ProprietorNo
Enumeration DateOctober 19, 2011
Last NPPES UpdateDecember 3, 2014
✔ NPI 1457636615 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 · 19721
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.
1100 GLENWOOD AVE, Minneapolis, MN 55405
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jessica Elizabeth Holly Licsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2022 through April 1, 2028.

Opt-Out Effective DateApril 1, 2022
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

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

SYDNEY BARTZ MSW, LICSW
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
KRISTINE WEBER MSW, LICSW
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
LAURA T BURKHARDT LICSW
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
HANNAH DANIELLE SHIER
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
RACHEL WILLERT MA, LPCC
Counselor (Professional)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
KAREN M KEEGAN LICSW
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
MEGAN VARELA
Social Worker (Clinical)
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454
AMANDA THOMAS LMFT
Marriage & Family Therapist
1100 GLENWOOD AVE
MINNEAPOLIS, MN 55405
Hennepin County (612) 871-1454

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 Holly's NPI number?

The NPI number for Jessica Holly is 1457636615. It was assigned to this individual provider in the NPPES registry on October 19, 2011.

Where is Jessica Holly located?

Jessica Holly practices at 1100 Glenwood Ave, Minneapolis, MN 55405. The listed phone number is (612) 871-1454.

What is Jessica Holly's specialty?

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

Is Jessica Holly enrolled in Medicare?

No. Jessica Holly has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Jessica Holly was last updated on December 3, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years 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.