Individual
MONICA I JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
810 LINCOLN STREET, KEWAUNEE, WI 54216
(920) 388-7030
(920) 388-7044
Mailing address
810 LINCOLN STREET, KEWAUNEE, WI 54216
(920) 388-7030
(920) 388-7044
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1595057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39089700
—
WI
Enumeration date
09/26/2006
Last updated
07/08/2007
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