Provider Demographics
NPI:1477193944
Name:LEAH JACOB LICSW LLC
Entity Type:Organization
Organization Name:LEAH JACOB LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-805-4206
Mailing Address - Street 1:100 W FRANKLIN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2446
Mailing Address - Country:US
Mailing Address - Phone:612-805-4206
Mailing Address - Fax:
Practice Address - Street 1:100 W FRANKLIN AVE STE 301
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2446
Practice Address - Country:US
Practice Address - Phone:612-805-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health