Healthcare Provider Details

I. General information

NPI: 1033681770
Provider Name (Legal Business Name): STEPHANIE ERIN JACOBS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

4166 JORA LN
CINCINNATI OH
45209-1407
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-4673
  • Fax: 513-873-3385
Mailing address:
  • Phone: 513-310-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2106921
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.181351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: