Provider Demographics
NPI:1598765265
Name:JACOBEL, PAMALA WOOD (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:PAMALA
Middle Name:WOOD
Last Name:JACOBEL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
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Mailing Address - Street 1:405 MANITOU ST
Mailing Address - Street 2:PO BOX 738
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1514
Mailing Address - Country:US
Mailing Address - Phone:507-645-4253
Mailing Address - Fax:507-645-6658
Practice Address - Street 1:402 WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-5190
Practice Address - Country:US
Practice Address - Phone:507-645-4253
Practice Address - Fax:507-645-6658
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2861103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN574048700Medicaid
MN574048700Medicaid
MNON655JAMedicare UPIN