Healthcare Provider Details

I. General information

NPI: 1962378349
Provider Name (Legal Business Name): ALIXANDRIA JACOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 LAKE ST
LINCOLN NE
68502-3734
US

IV. Provider business mailing address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-5268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8289
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-2436
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14647
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: