Provider Demographics
NPI:1619153624
Name:DELLE JACOBS, LIMITED
Entity Type:Organization
Organization Name:DELLE JACOBS, LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELLE
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:651-642-9883
Mailing Address - Street 1:91 SNELLING AVE N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6753
Mailing Address - Country:US
Mailing Address - Phone:651-642-9883
Mailing Address - Fax:651-642-5909
Practice Address - Street 1:91 SNELLING AVE N
Practice Address - Street 2:SUITE 230
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6753
Practice Address - Country:US
Practice Address - Phone:651-642-9883
Practice Address - Fax:651-642-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17851041C0700X
MN699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN298057600Medicaid
MN800001651Medicare PIN