Provider Demographics
NPI:1144576802
Name:JACOBSON, MARIANNE D (PCD CLE GSC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:D
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PCD CLE GSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23622 165TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9102
Mailing Address - Country:US
Mailing Address - Phone:206-999-6362
Mailing Address - Fax:
Practice Address - Street 1:23622 165TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-9102
Practice Address - Country:US
Practice Address - Phone:206-999-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601364515374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula