Provider Demographics
NPI:1265751440
Name:JACOBS, KRISTEN A (MSW, LSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:FREUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1010 CURTISS ST
Mailing Address - Street 2:C6
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4769
Mailing Address - Country:US
Mailing Address - Phone:630-956-2528
Mailing Address - Fax:
Practice Address - Street 1:346 TAFT AVE
Practice Address - Street 2:030
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6296
Practice Address - Country:US
Practice Address - Phone:630-956-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.012815104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker