Provider Demographics
NPI:1447568068
Name:JACOBSON, MELISSA MICHELLE (BED)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:MICHELLE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 CENTENNIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2421
Mailing Address - Country:US
Mailing Address - Phone:541-485-6340
Mailing Address - Fax:541-984-3124
Practice Address - Street 1:2145 CENTENNIAL PLZ
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2421
Practice Address - Country:US
Practice Address - Phone:541-485-6340
Practice Address - Fax:541-984-3124
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator