Provider Demographics
NPI:1356657688
Name:JACOBSON, JULIE ELAINE
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELAINE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311B SPRINGER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-7902
Mailing Address - Country:US
Mailing Address - Phone:573-489-8236
Mailing Address - Fax:
Practice Address - Street 1:1311B SPRINGER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-7902
Practice Address - Country:US
Practice Address - Phone:573-489-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist