Individual
SUE JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
6221 RICHARDS DR, SHAWNEE, KS 66216-1724
(913) 248-1943
(913) 248-1994
Mailing address
130 E 5TH ST, PO BOX 711, NEWTON, KS 67114-2206
(316) 283-6743
(316) 283-6830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
260
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106710 I
—
KS
Enumeration date
06/13/2014
Last updated
06/13/2014
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