Healthcare Provider Details

I. General information

NPI: 1619153624
Provider Name (Legal Business Name): DELLE JACOBS, LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 SNELLING AVE N SUITE 230
SAINT PAUL MN
55104-6753
US

IV. Provider business mailing address

91 SNELLING AVE N SUITE 230
SAINT PAUL MN
55104-6753
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-9883
  • Fax: 651-642-5909
Mailing address:
  • Phone: 651-642-9883
  • Fax: 651-642-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1785
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number699
License Number StateMN

VIII. Authorized Official

Name: MS. DELLE MARIAN JACOBS
Title or Position: LICENSED SOCIAL WORKER
Credential: LICSW
Phone: 651-642-9883