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KELLY JEAN TIBBETTS LICSW
NPI 1992350367
Social Worker - Clinical in Spring Park, MN

Active since August 02, 2019PECOS Enrolled
4154 SHORELINE DR STE 202, SPRING PARK, MN 55384(952) 491-9450 Get Directions Write a Review

NPPES record last updated: June 6, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 6, 2025, Feb 18, 2025, Aug 2, 2019 (3 updates tracked since 2019).

About Kelly Jean Tibbetts Licsw NPPES

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

KELLY JEAN TIBBETTS LICSW (NPI 1992350367) is an individual clinical provider in Spring Park, Minnesota, licensed in Minnesota (22636) and active in the NPI registry since August 2019. She is enrolled in Medicare PECOS, maintains a secondary practice location in Cottage Grove, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1992350367
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLY JEAN TIBBETTSCredential: LICSW
Location Address4154 SHORELINE DR STE 202Spring Park, MN 55384-5610
Mailing AddressPo Box 13Wrenshall, MN 55797-0013 · (218) 409-7508
Phone(952) 491-9450
Sole ProprietorYes
Medical School CMSOtherGraduated 2016
Enumeration DateAugust 2, 2019
Last NPPES UpdateJune 6, 20253 updates tracked since enumeration
NPPES CertifiedJune 6, 2025
✔ NPI 1992350367 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 · 22636
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.
4154 SHORELINE DR STE 202, Spring Park, MN 55384
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Secondary Practice Location 1

Location 17501 80th St SCottage Grove, MN 55016-3020 · Phone (218) 409-7508

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Jean Tibbetts Licsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7911493861
PECOS Enrollment IDI20251231000701
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 55384 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 3

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

MINDFULLY HEALING INC.
Counselor (Mental Health)
4154 SHORELINE DR STE 202
SPRING PARK, MN 55384
Hennepin County (952) 491-9450
ASHLEY NICOLE WURDEMAN LMFT
Marriage & Family Therapist
4154 SHORELINE DR STE 202
SPRING PARK, MN 55384
Hennepin County (952) 491-9450
MITCHELL LEE OLSON LPCC
Counselor (Mental Health)
4154 SHORELINE DR STE 202
SPRING PARK, MN 55384
Hennepin County (612) 562-9880

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 Kelly Tibbetts's NPI number?

The NPI number for Kelly Tibbetts is 1992350367. It was assigned to this individual provider in the NPPES registry on August 2, 2019.

Where is Kelly Tibbetts located?

Kelly Tibbetts practices at 4154 Shoreline Dr Ste 202, Spring Park, MN 55384. The listed phone number is (952) 491-9450.

What is Kelly Tibbetts's specialty?

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

Is Kelly Tibbetts enrolled in Medicare?

Yes. Kelly Tibbetts is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Tibbetts accept?

Health plans from HealthPartners list Kelly Tibbetts as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Tibbetts was last updated on June 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.