Provider Demographics
NPI:1497769038
Name:JACOBSON, ERIN (LCPC, ATR)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 WESLEY AVE
Mailing Address - Street 2:1
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1857
Mailing Address - Country:US
Mailing Address - Phone:708-712-9255
Mailing Address - Fax:
Practice Address - Street 1:235 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1533
Practice Address - Country:US
Practice Address - Phone:708-712-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01-229OtherREGISTERED ART THERAPIST