Kelli Clark Jacobsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6953774-3501 Issued in UT

Practice address

450 S 900 E Ste 300
Salt Lake City, UT 84102-3064

Phone

(801) 534-7916

Fax

(801) 532-3608

NPI assigned

Feb 15, 2007

Sex

Female

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287360000000",
    "number": "1871636043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 S 900 E STE 300",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023064",
            "telephone_number": "801-534-7916",
            "fax_number": "801-532-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S 900 E STE 300",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023064",
            "telephone_number": "801-534-7916",
            "fax_number": "801-532-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "KELLI",
        "middle_name": "CLARK",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2010-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "6953774-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeniel Lovell Jacobs, DNP
• Julia Jacobs, PSY.D.
• Allison Jacobsen
• Debra Ann Jacobsen, MS
• Jorgan Hoggan Jacobsen, PA-C
• Stephanie Dawn Jacobsen
• Kristin Jacobson Messner, SLP
• Bruce Kenneth Jacobson, PH.D., P.C.
• Bryanna Jacobson
• Carlene Jacobson, RN

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; 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.