Jack Jacobsen, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2007031620 Issued in MO

Practice address

24 S Gore Ave
Webster Groves, MO 63119-2910

Phone

(314) 736-5446

NPI assigned

Feb 6, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cooperative Therapy LLC

  • Clinical Social Worker
  • Kirkwood, MO
  • NPI 1780136945
  NPD (past) Authorized official
• Compass Health, Inc.

  dba Pathways Community Behavioral Healthcare

  • Federally Qualified Health Center (FQHC)
  • Saint Charles, MO
  • NPI 1083033591
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1679751291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 ALFRED AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631161809",
            "telephone_number": "314-569-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 S GORE AVE",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631192910",
            "telephone_number": "314-736-5446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 N Gould St Ste R",
            "address_purpose": "LOCATION",
            "city": "Sheridan",
            "state": "WY",
            "postal_code": "828016317",
            "country_code": "US",
            "telephone_number": "303-517-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "JACK",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-06",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2007031620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Huynh, DMD
• Imagine Peace
• In Your Prime Counseling LLC (In Your Prime Counseling)
• Inner Connection Inc
• Quiana Jackson, FNP
• Lisa Hope Jain
• Crista L Jamous, FNP
• Edward Stanley Jarka, OD
• Jason Wibbenmeyer Chiropractic, LLC (Innovative Health Partners)
• Katelyn Jensen, MSW, LCSW

• Clinical Social Worker in Webster Groves, MO
• Providers in Webster Groves, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.