Provider Demographics
NPI:1578971842
Name:JACOBSEN, MALLORY LYNN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:LYNN
Last Name:JACOBSEN
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Gender:F
Credentials:MSW, LICSW
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Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-6872
Mailing Address - Fax:633-153-5397
Practice Address - Street 1:9400 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1814
Practice Address - Country:US
Practice Address - Phone:763-762-6872
Practice Address - Fax:763-315-3539
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN281181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical