Healthcare Provider Details

I. General information

NPI: 1013822048
Provider Name (Legal Business Name): TERESA LYNN JACOBSON MSW, LSW, CAPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 GRAYSIDE AVE
MAUSTON WI
53948-1913
US

IV. Provider business mailing address

E9371 PARTRIDGE DR
REEDSBURG WI
53959-9079
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-7575
  • Fax: 608-847-3096
Mailing address:
  • Phone: 608-847-7575
  • Fax: 608-847-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129216-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: