Provider Demographics
NPI:1760125926
Name:JACOBSON, ELIZABETH LAUREN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAUREN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-6831
Mailing Address - Country:US
Mailing Address - Phone:847-915-8274
Mailing Address - Fax:
Practice Address - Street 1:1650 MOON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1010
Practice Address - Country:US
Practice Address - Phone:847-755-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0232481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical