Provider Demographics
NPI:1164962957
Name:JACOBI, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JACOBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ELBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 DIVISION ST S
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2095
Mailing Address - Country:US
Mailing Address - Phone:651-605-6020
Mailing Address - Fax:651-605-6020
Practice Address - Street 1:401 DIVISION ST S
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2095
Practice Address - Country:US
Practice Address - Phone:651-605-6020
Practice Address - Fax:651-605-6020
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN197021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical