Provider Demographics
NPI:1811945033
Name:JACOBSEN, CYNTHIA H (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:H
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12113 NORWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1204
Mailing Address - Country:US
Mailing Address - Phone:816-234-3760
Mailing Address - Fax:816-234-3291
Practice Address - Street 1:2401 GILLHAM ROAD
Practice Address - Street 2:CHILDREN'S MERCY HOSPITAL
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-234-3760
Practice Address - Fax:816-234-3291
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00618235Z00000X
KS00600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist