Healthcare Provider Details

I. General information

NPI: 1306259643
Provider Name (Legal Business Name): ERIKA JEAN JACOBSON CSW-PIP, CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

IV. Provider business mailing address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax: 612-725-1356
Mailing address:
  • Phone: 605-336-3230
  • Fax: 612-725-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4866
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier470830662
Identifier TypeMEDICAID
Identifier StateNE
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: