# MR. JAKE HEATH JACOBSEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1992932479
- **Gender:** Man
- **Credential:** ATR, LCSW

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 069903 | NY | — |
| 1041C0700X | Clinical Social Worker | 069903-1 | NY | — |
| 1041C0700X | Clinical Social Worker | L6016 | OR | Yes |

## Other

- **Enumeration date:** 06/11/2009
- **Last updated:** 09/22/2014