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General NPI Number Information
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NPI Number | 1275314585
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Entity Type | Individual
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Provider Name | RYLIE MADISON JACOBSEN
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 809 S 174TH ST
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City | OMAHA
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State | NE
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Zip | 68118-3540
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Country | US
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Telephone | 402-991-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 N 60TH ST APT 416
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City | OMAHA
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State | NE
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Zip | 68104-3452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14408
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License Number State | NE
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