Provider Demographics
NPI:1417582388
Name:JACOBSEN, KRISTEN (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROCKWOOD HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1029
Mailing Address - Country:US
Mailing Address - Phone:978-241-2442
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3329
Practice Address - Country:US
Practice Address - Phone:978-369-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist