Healthcare Provider Details

I. General information

NPI: 1588568802
Provider Name (Legal Business Name): ANNE JACOBSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 N WEST ST
WICHITA KS
67203-1335
US

IV. Provider business mailing address

1607 N WEST ST
WICHITA KS
67203-1335
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-0600
  • Fax:
Mailing address:
  • Phone: 316-973-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7196
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: