Provider Demographics
NPI:1265668792
Name:JACOBSON, TIFFANIE A (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:A
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 OAK PARK RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1010
Mailing Address - Country:US
Mailing Address - Phone:847-337-7734
Mailing Address - Fax:
Practice Address - Street 1:3150 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7237
Practice Address - Country:US
Practice Address - Phone:847-310-0074
Practice Address - Fax:847-310-1201
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004129133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered