Provider Demographics
NPI:1811186307
Name:JACOBOWSKI, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:JACOBOWSKI
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 1:119 STEPHEN ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-3660
Mailing Address - Country:US
Mailing Address - Phone:630-257-5757
Mailing Address - Fax:630-257-7055
Practice Address - Street 1:119 STEPHEN ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-3660
Practice Address - Country:US
Practice Address - Phone:630-569-0436
Practice Address - Fax:630-257-7055
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490108211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical