Provider Demographics
NPI:1790186286
Name:JENNIFER L JACOBY LLC
Entity Type:Organization
Organization Name:JENNIFER L JACOBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-804-2276
Mailing Address - Street 1:935 WINSLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1340
Mailing Address - Country:US
Mailing Address - Phone:612-804-2276
Mailing Address - Fax:
Practice Address - Street 1:935 WINSLOW AVE
Practice Address - Street 2:
Practice Address - City:WEST SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1340
Practice Address - Country:US
Practice Address - Phone:612-804-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty