Provider Demographics
NPI:1285757377
Name:JACOBS, EVELYN MAY (MSW)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:MAY
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-5130
Mailing Address - Country:US
Mailing Address - Phone:317-385-2154
Mailing Address - Fax:
Practice Address - Street 1:11950 FISHERS CROSSING DR.
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-555-5955
Practice Address - Fax:317-595-5554
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical