Individual provider Active NPI

Rebecca Lynn Jacobson, MSW, LICSW

  • Clinical Social Worker
  • Minneapolis, MN
National Provider Identifier
1770468753
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
16053 Issued in MN
Practice address
4027 County Road 25
Minneapolis, MN 55416-2629
Phone
(612) 925-6033
Fax
(612) 925-8496
NPI assigned
Aug 8, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 16053 MN Primary

Addresses

Primary practice location

4027 County Road 25
Minneapolis, MN 55416-2629

Mailing address

4240 Park Glen Rd
St Louis Park, MN 55416-5427
Phone (612) 925-6033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250922001707 MN Practitioner - Clinical Social Worker 4486158433

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4240 Park Glen Rd
St Louis Park, MN 55416-5427

7239 32ND Ave N
Crystal, MN 55427-2834

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1754611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1770468753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 COUNTY ROAD 25",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162629",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "REBECCA",
        "middle_name": "LYNN",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-08",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "16053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.