Healthcare Provider Details

I. General information

NPI: 1114872801
Provider Name (Legal Business Name): BRETT ANDREW JACOBSON LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1N730 MACQUEEN DR
WEST CHICAGO IL
60185-1961
US

IV. Provider business mailing address

1N730 MACQUEEN DR
WEST CHICAGO IL
60185-1961
US

V. Phone/Fax

Practice location:
  • Phone: 847-533-4360
  • Fax:
Mailing address:
  • Phone: 847-533-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.103480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: