Individual
MS. SUSAN RAE JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 NE COUCH ST, PORTLAND, OR 97232-2922
(503) 542-4603
(503) 233-6093
Mailing address
739 SE 130TH AVE, PORTLAND, OR 97233-1611
(503) 724-7724
(503) 467-0582
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/30/2013
Last updated
08/30/2013
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