Kelly Jean Tibbetts, LICSW
Clinical Social Worker · Spring Park, MN
Kelly Jean Tibbetts, LICSW is a clinical social worker with a practice address in Spring Park, Minnesota, and NPI 1992350367, issued on Aug 2, 2019. Check the license (Minnesota 22636, as entered in NPPES) with the Minnesota board that licenses this profession; the Medicare figures below come from public CMS files.
- Name
- Kelly Jean Tibbetts
- Credential
- LICSW
- Primary taxonomy
- Clinical Social Worker 1041C0700X
- License number
- 22636 MN
Self-reported in NPPES; status is on the state search - Practice location
- 4154 Shoreline Dr Ste 202, Spring Park, MN 55384
- Phone
- (952) 491-9450
- Enumerated
- Aug 2, 2019
- Record last updated
- Jun 6, 2025
- Medicare enrollment
- Enrolled (PECOS I20251231000701); may accept Medicare assignment
- Entity
- Type 1 · individual
Also registered at 4154 Shoreline Dr Ste 202
A shared address usually means a shared clinic or building; it does not show who employs whom.
- Mitchell Olson, LPCCMental Health Counselor1831677103
- Ashley Wurdeman, LMFTMarriage & Family Therapist1750063301
Verify Kelly Jean Tibbetts in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersWhich Minnesota board licenses this profession
Search for license 22636Check the board - 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
Bills Medicare through one group practice
- Restorative Behavioral Health ServicesHutchinson, MN
Source: CMS Doctors and Clinicians National Downloadable File (the group practices a clinician bills Medicare through) (data.cms.gov).
3 clinical social worker records list a practice address in Spring Park
They are 3 of the 25 NPPES records with a practice address in Spring Park, and 6,609 clinical social worker records in Minnesota.
All 3 in Spring Park → All 6,609 in Minnesota → Every provider in Spring Park →
Other clinical social worker records in Minnesota
- Sherry Aadland, LICSWMinneapolis, MN1740420355
- Ross Aalgaard, DSW, LICSW, LADCMankato, MN1275866253
- Jessica AamotMinneapolis, MN1295674877
- Victoria Abbene, LICSWMinneapolis, MN1205379757
- Geoffrey Abbott, LICSWMinneapolis, MN1952345639
- Tammy Abbott, MSW LICSWMinneapolis, MN1164633525
- Jibril AbdiBurnsville, MN1053057497
- Layla Abdi, LICSWMinneapolis, MN1356899124
- Qamar AbdiMinneapolis, MN1922806652
- Saida Abdi, LICSWMinneapolis, MN1538440458
Common questions
What is Kelly Jean Tibbetts, LICSW's NPI number?
Kelly Jean Tibbetts, LICSW's National Provider Identifier (NPI) is 1992350367, issued on Aug 2, 2019. An NPI identifies a provider in billing; it is not a license.
Where is Kelly Jean Tibbetts, LICSW located?
The NPPES record lists a practice address at 4154 Shoreline Dr Ste 202, Spring Park, MN, 55384. Phone: (952) 491-9450. Providers update this record themselves, so call before visiting.
How can I verify Kelly Jean Tibbetts, LICSW's license?
NPPES lists Minnesota license number 22636, as entered by the provider. Search the Minnesota board that licenses this profession; the NPPES record confirms identity only.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.