Individual
JACK JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
24 S GORE AVE, WEBSTER GROVES, MO 63119-2910
(314) 736-5446
Mailing address
3211 ALFRED AVE, SAINT LOUIS, MO 63116-1809
(314) 569-9731
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2007031620
MO
Other
Enumeration date
02/06/2008
Last updated
01/19/2021
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