Provider Demographics
NPI:1790008027
Name:JACOBSEN, VERONICA (CD(DONA), LCCE, CLC)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:CD(DONA), LCCE, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2520
Mailing Address - Country:US
Mailing Address - Phone:612-866-3353
Mailing Address - Fax:
Practice Address - Street 1:4590 SCOTT TRL STE 102
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-5203
Practice Address - Country:US
Practice Address - Phone:651-200-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN