Provider Demographics
NPI:1952916538
Name:JACOBSON, DONALD EUGENE JOSEPH JR
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE JOSEPH
Last Name:JACOBSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 S DORAN APT 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2237
Mailing Address - Country:US
Mailing Address - Phone:844-546-1212
Mailing Address - Fax:844-546-1212
Practice Address - Street 1:31 E VERNON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1338
Practice Address - Country:US
Practice Address - Phone:844-546-1212
Practice Address - Fax:844-546-1212
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician