Individual
IVE GRACE JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 SE HAILEY AVE STE 307, PENDLETON, OR 97801-3072
(541) 663-4104
(541) 429-8822
Mailing address
PO BOX 882, PENDLETON, OR 97801-0882
(541) 429-8844
(541) 429-8822
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
THW000109264
OR
Other
Enumeration date
08/08/2023
Last updated
08/08/2023
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