Provider Demographics
NPI:1730885856
Name:JACOBSEN, KAYLA ANDREA (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANDREA
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROOSEVELT CIR APT 317
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-1519
Mailing Address - Country:US
Mailing Address - Phone:507-440-4929
Mailing Address - Fax:
Practice Address - Street 1:200 ROOSEVELT CIR APT 317
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-1519
Practice Address - Country:US
Practice Address - Phone:507-440-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker