Provider Demographics
NPI:1679506448
Name:JACOBSON, ANGELA LYNN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:18612 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9764
Mailing Address - Country:US
Mailing Address - Phone:206-484-1513
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:E2-102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-288-6990
Practice Address - Fax:206-288-1025
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS