Provider Demographics
NPI:1417293481
Name:JACOBS, SUSAN L (ND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KILBURN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4750
Mailing Address - Country:US
Mailing Address - Phone:802-540-0066
Mailing Address - Fax:
Practice Address - Street 1:13 KILBURN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4750
Practice Address - Country:US
Practice Address - Phone:802-540-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0090445175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath