Provider Demographics
NPI:1821644592
Name:JACOBSON, KRISTIN AARYN (LM, MSM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:AARYN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LM, MSM
Other - Prefix:
Other - First Name:KRISSY
Other - Middle Name:
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, MSM
Mailing Address - Street 1:286 CHUCKANUT POINT RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-8978
Mailing Address - Country:US
Mailing Address - Phone:513-846-2129
Mailing Address - Fax:
Practice Address - Street 1:1600 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3040
Practice Address - Country:US
Practice Address - Phone:360-734-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA176B00000X
WAMW60955829176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife