Provider Demographics
NPI:1548349418
Name:JACOBSON, SHARI G (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHARI
Middle Name:G
Last Name:JACOBSON
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 1:900 NORTH SHORE DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2225
Mailing Address - Country:US
Mailing Address - Phone:847-295-6141
Mailing Address - Fax:888-765-7036
Practice Address - Street 1:900 NORTH SHORE DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2225
Practice Address - Country:US
Practice Address - Phone:847-295-6141
Practice Address - Fax:888-765-7036
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149000038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932087OtherBCBS
IL205259Medicare ID - Type Unspecified