Provider Demographics
NPI:1255683066
Name:JACOBSON, PAMELA JEAN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-0787
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:855-625-7406
Practice Address - Street 1:517 N 17TH ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-3067
Practice Address - Country:US
Practice Address - Phone:320-269-6581
Practice Address - Fax:855-562-7905
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical