Individual
MARY LOU JACOBSEN
Active
Individual
MARY LOU JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSSW, LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8206
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074027600
—
MN
01
—
118039
UCARE
MN
01
—
4G504WA
BLUE CROSS BLUE SHIELD
MN
01
—
62-20365
UNITED BEHAVIORAL HEALTH
MN
01
—
HP20016
HEALTH PARTNERS
MN
Enumeration date
10/12/2006
Last updated
02/10/2021
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