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Individual

DANIELLE B JACOBS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-5052
(715) 284-5361
Mailing address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-5052
(715) 284-5361

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7131-123
WI
106H00000X
Marriage & Family Therapist
7131-123
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40980700
WI
Enumeration date
07/20/2006
Last updated
06/12/2020
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