Provider Demographics
NPI:1376059022
Name:JACOBS, ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2409
Mailing Address - Country:US
Mailing Address - Phone:800-592-0180
Mailing Address - Fax:712-566-5229
Practice Address - Street 1:80 N EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-7340
Practice Address - Country:US
Practice Address - Phone:641-423-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0866511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical