Individual
DUSTIN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3450 OLEARY LN, EAGAN, MN 55123-2340
(651) 454-0114
Mailing address
2523 28TH AVE S APT 2, MINNEAPOLIS, MN 55406-3194
(612) 860-6348
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149.016078
IL
1041C0700X
Clinical Social Worker
Primary
27099
MN
Other
Enumeration date
02/07/2014
Last updated
04/23/2018
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