Provider Demographics
NPI:1598221699
Name:JACOBSEN, ALLESSANDRA CORINE (LAMFT)
Entity Type:Individual
Prefix:
First Name:ALLESSANDRA
Middle Name:CORINE
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N MAIN ST STE 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-4016
Mailing Address - Country:US
Mailing Address - Phone:435-660-0720
Mailing Address - Fax:
Practice Address - Street 1:1220 N MAIN ST STE 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-4016
Practice Address - Country:US
Practice Address - Phone:435-660-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11159724-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist