Basic Information
| Provider Information | |||||||||
| NPI: | 1134496045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1286 PRAIRIE VIEW PKWY | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600132621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473085668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 ROHLWING RD | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475248800 | ||||||||
| FaxNumber: | 8475248824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2011 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149.015290 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.