Provider Demographics
NPI:1053027805
Name:JACOBSEN, LINDSEY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:MARIE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 TALC TRAIL APT. 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-400-3672
Mailing Address - Fax:
Practice Address - Street 1:6410 ENTERPRISE LANE
Practice Address - Street 2:SUITE 210
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-400-3672
Practice Address - Fax:608-422-4006
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132637-121104100000X
WI11730-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker