Jacobsen, Mary Lou

Jacobsen, Mary Lou is an individual health care provider with primary practice located at 610 Florence Ave , Owatonna MN 55060-4704. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jacobsen, Mary Lou can be contacted via phone (507) 451-2630.

Contact Information

Primary practice address
610 Florence Ave Owatonna MN 55060-4704
Phone: (507) 451-2630
Fax: (507) 455-8133
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 8206 Minnesota

Profile Details

NPI number 1295824696
LBN Legal business name Jacobsen, Mary Lou
Credentials MSSW, LICSW
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2006
Last updated Feb 10th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295824696 NPPES
Minnesota Other 4G504WA BLUE CROSS BLUE SHIELD
Minnesota Other 118039 BLUE CROSS BLUE SHIELD
Minnesota Other 62-20365 BLUE CROSS BLUE SHIELD
Minnesota MEDICAID 074027600 BLUE CROSS BLUE SHIELD
Minnesota Other HP20016 BLUE CROSS BLUE SHIELD

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