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Individual
REBECCA JACOBSEN
Active
Individual
REBECCA JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY11203
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PL112030
BLUE SHIELD
CA
01
—
PSY112030
MEDICAL
CA
Enumeration date
07/15/2006
Last updated
07/08/2007
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