Active NPI
Mary Jacobson, SW,SAC-IT
- Addiction (Substance Use Disorder) Counselor
- La Crosse, WI
National Provider Identifier
1912524976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 19001-130
- Practice address
- 300 4TH St N
La Crosse, WI 54601-3228 - Phone
- (608) 784-4357
- Fax
- (608) 785-6122
- NPI assigned
- Jun 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 19001-130 | WI | Primary |
Addresses
Primary practice location
300 4TH St N
La Crosse, WI 54601-3228
Mailing address
300 4TH St N
La Crosse, WI 54601-3228
Phone (608) 784-4357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19001-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593043200000",
"number": "1912524976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 4TH ST N",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546013228",
"telephone_number": "608-784-4357",
"fax_number": "608-785-6122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 4TH ST N",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546013228",
"telephone_number": "608-784-4357",
"fax_number": "608-785-6122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "MARY",
"credential": "SW,SAC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-25",
"last_updated": "2020-06-25",
"certification_date": "2020-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "19001-130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.