Provider Demographics
NPI:1902371412
Name:JACOBSON, JESSICA KAY (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KAY
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KAY
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:714 W. COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-728-7198
Mailing Address - Fax:651-323-2184
Practice Address - Street 1:714 W. COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-728-7198
Practice Address - Fax:651-323-2184
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN248411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical