Provider Demographics
NPI:1679814461
Name:JACOBSON, SYDNEY ELIZABETH (RD)
Entity Type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:ELIZABETH
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1436
Mailing Address - Country:US
Mailing Address - Phone:515-279-4225
Mailing Address - Fax:
Practice Address - Street 1:7101 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1436
Practice Address - Country:US
Practice Address - Phone:515-279-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered