Provider Demographics
NPI:1467444521
Name:JACOBS, LOUISE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0174
Mailing Address - Country:US
Mailing Address - Phone:402-460-8191
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:STE 240
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3239
Practice Address - Country:US
Practice Address - Phone:402-460-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025358700Medicaid
NE10025358700Medicaid