Healthcare Provider Details

I. General information

NPI: 1548170814
Provider Name (Legal Business Name): KORENE JACOBS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 E SPEEDWAY BLVD
TUCSON AZ
85712-5301
US

IV. Provider business mailing address

4585 E SPEEDWAY BLVD
TUCSON AZ
85712-5301
US

V. Phone/Fax

Practice location:
  • Phone: 520-606-4031
  • Fax:
Mailing address:
  • Phone: 520-606-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-19964
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: