Individual
DR. SCOTT MICHAEL JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2110 LYNDALE AVE S, MINNEAPOLIS, MN 55405-3196
(952) 353-5931
Mailing address
935 WINSLOW AVE, WEST ST PAUL, MN 55118-1340
(612) 669-3430
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
5269
MN
103TC0700X
Clinical Psychologist
Primary
5269
MN
103TP2701X
Group Psychotherapy Psychologist
5269
MN
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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