Leah Gail Jacob, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24285 Issued in MN

Practice address

3450 Oleary LN
Eagan, MN 55123-2340

Phone

(651) 365-8279

NPI assigned

Jun 15, 2017

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

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.

Opted out of Medicare

Yes, effective Mar 30, 2020 through Mar 30, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Leah Jacob Licsw LLC

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1477193944
  NPD Authorized official

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891225439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 OLEARY LN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232340",
            "telephone_number": "651-365-8279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 OLEARY LN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232340",
            "telephone_number": "651-365-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "LEAH",
        "middle_name": "GAIL",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sadio Ismail, RN
• Mohamed Abdullahi Isse
• J-Revival LLC
• Korie Jackson
• Dustin Jacob, LICSW
• Veronica Jacobsen, CD(DONA), LCCE, CLC
• Aaron Jacobson, D.C.
• Luke Matthew Jakubowski, D.C.
• Jama Transportation LLC
• Ahmed B Jama

• Clinical Social Worker in Eagan, MN
• Providers in Eagan, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.