Provider Demographics
NPI:1932698834
Name:JACOBSON, JOHN D (DVM, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DVM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 EARHART CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4739
Mailing Address - Country:US
Mailing Address - Phone:785-764-2019
Mailing Address - Fax:
Practice Address - Street 1:5040 BOB BILLINGS PKWY STE A1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3873
Practice Address - Country:US
Practice Address - Phone:785-764-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5229103T00000X, 103TH0100X
KS2599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service