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NPI Code Detail

MEDICARE: TRACY MICHELLE JACOBS

MEDICARE: TRACY MICHELLE JACOBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149.021732IL

General Provider Information

NPI Number : 1023655750
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY MICHELLE JACOBS
Provider Business Mailing Address
First Line : 507 N 5TH ST
Second Line :
City : OREGON
State : IL
Zip : 61061-1203
Country : US
Telephone Number : 815-262-4856
Fax Number :
Provider Business Practice Location Address
First Line : 1658 S IL ROUTE 2
Second Line :
City : OREGON
State : IL
Zip : 61061-9514
Country : US
Telephone Number : 815-732-2499
Fax Number : 815-732-6077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2019
Last Update Date : 12/10/2020

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Directions to “ TRACY MICHELLE JACOBS ” Practice Location

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