Provider Demographics
NPI:1609126960
Name:JACOBSON, HEATHER L
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 UNDERWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2439
Mailing Address - Country:US
Mailing Address - Phone:425-275-2495
Mailing Address - Fax:
Practice Address - Street 1:4801 UNDERWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2439
Practice Address - Country:US
Practice Address - Phone:425-275-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist