Provider Demographics
NPI:1669662698
Name:JACOBSEN, AMY MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARGARET
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8400 W. 110TH STREET
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-631-3800
Mailing Address - Fax:913-948-7317
Practice Address - Street 1:8400 W. 110TH STREET
Practice Address - Street 2:SUITE 610
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-631-3800
Practice Address - Fax:913-948-7317
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1667103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral