Provider Demographics
NPI:1982863031
Name:JACOBSON, KAREN ROBSON (MA LCPC LMFT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ROBSON
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MA LCPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N WIELAND ST
Mailing Address - Street 2:UNIT N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1239
Mailing Address - Country:US
Mailing Address - Phone:312-330-3194
Mailing Address - Fax:312-266-3616
Practice Address - Street 1:1401 N WIELAND ST
Practice Address - Street 2:UNIT N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-7201
Practice Address - Country:US
Practice Address - Phone:312-330-3194
Practice Address - Fax:312-266-3616
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000576101YP2500X
IL166000444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist