Provider Demographics
NPI:1134299084
Name:JACOBS, VICKI TOUSTER (MSW)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:TOUSTER
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PARMENTER RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3280
Mailing Address - Country:US
Mailing Address - Phone:603-437-2069
Mailing Address - Fax:603-434-5588
Practice Address - Street 1:12 PARMENTER RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3280
Practice Address - Country:US
Practice Address - Phone:603-437-2069
Practice Address - Fax:603-434-5588
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007468Medicaid