Provider Demographics
NPI:1376771774
Name:JACOBY, KYNDAL C (MSW)
Entity Type:Individual
Prefix:
First Name:KYNDAL
Middle Name:C
Last Name:JACOBY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GOVERNMENT ST
Mailing Address - Street 2:BLDG 1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5820
Mailing Address - Country:US
Mailing Address - Phone:225-922-0445
Mailing Address - Fax:225-922-2707
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BLDG 1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5820
Practice Address - Country:US
Practice Address - Phone:225-922-0445
Practice Address - Fax:225-922-2707
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical