Provider Demographics
NPI:1619173432
Name:JACOBSEN, LINDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:JACOBSEN
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 1:43977 STERLING HWY STE F
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8053
Mailing Address - Country:US
Mailing Address - Phone:907-260-5400
Mailing Address - Fax:
Practice Address - Street 1:43977 STERLING HWY STE F
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8053
Practice Address - Country:US
Practice Address - Phone:907-260-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK03861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152584Medicare ID - Type Unspecified