Provider Demographics
NPI:1043384639
Name:JACOBS, DELLE MARIAN (MSW, LICSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:DELLE
Middle Name:MARIAN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW, LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SNELLING AVE N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6753
Mailing Address - Country:US
Mailing Address - Phone:651-642-9883
Mailing Address - Fax:651-642-5909
Practice Address - Street 1:91 SNELLING AVE N
Practice Address - Street 2:SUITE 230
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6753
Practice Address - Country:US
Practice Address - Phone:651-642-9883
Practice Address - Fax:651-642-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17851041C0700X
MN699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist