Provider Demographics
NPI:1558414458
Name:JACOBSON, ANN PILAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:PILAR
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 ANTIOCH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2119
Mailing Address - Country:US
Mailing Address - Phone:913-663-1763
Mailing Address - Fax:913-469-0604
Practice Address - Street 1:10925 ANTIOCH RD STE 103
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2119
Practice Address - Country:US
Practice Address - Phone:913-663-1763
Practice Address - Fax:913-469-0604
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS828103T00000X
MO01551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0009858Medicare ID - Type Unspecified