Mr Kenneth William Jacob, LSW is a
Social Worker - Clinical based in Mansfield, Ohio. Mr Kenneth William Jacob is licensed to practice in Ohio (license number S.0500567) and his current practice location is
680 Park Ave W, Mansfield, Ohio. He can be reached at his office (for appointments etc.) via phone at
(419) 528-5993.
NPI number for Mr Kenneth William Jacob is 1174780183 and his current mailing address is 680 Park Ave W, Mansfield, Ohio. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1174780183.
Healthcare Provider's Profile
| Full Name | Mr Kenneth William Jacob |
|---|
| Gender | Male |
|---|
| Speciality | Social Worker - Clinical |
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| Location | 680 Park Ave W, Mansfield, Ohio |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1174780183
- Provider Enumeration Date: 05/19/2008
- Last Update Date: 03/07/2019
Medical Identifiers
Medical identifiers for Mr Kenneth William Jacob such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1174780183 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 011389 (Ohio) | Secondary |
| 1041C0700X | Social Worker - Clinical | S.0500567 (Ohio) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Kenneth William Jacob is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Kenneth William Jacob, LSW
680 Park Ave W,
Mansfield, OH 44906-3706
Ph: (419) 528-5993 | Mr Kenneth William Jacob, LSW
680 Park Ave W,
Mansfield, OH 44906-3706
Ph: (419) 528-5993 |
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