Provider Demographics
NPI:1528581790
Name:JACOBSON, REBECCA WOLF (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:WOLF
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 N DAYTON ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0999
Mailing Address - Country:US
Mailing Address - Phone:847-421-9136
Mailing Address - Fax:
Practice Address - Street 1:1827 N DAYTON ST UNIT E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-0999
Practice Address - Country:US
Practice Address - Phone:847-421-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0178961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical