1265751440 NPI number — MRS. KRISTEN A. JACOBS MSW, LSW

Table of content: MRS. KRISTEN A. JACOBS MSW, LSW (NPI 1265751440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265751440 NPI number — MRS. KRISTEN A. JACOBS MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
KRISTEN
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREUND
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265751440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 CURTISS ST
Provider Second Line Business Mailing Address:
C6
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-4769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-956-2528
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 TAFT AVE
Provider Second Line Business Practice Location Address:
030
Provider Business Practice Location Address City Name:
GLEN ELLYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60137-6296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-956-2528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  150.012815 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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