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Individual

DR. GLENN R. JACOBSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7 COURTYARD OFFICES, 1372 N. SUSQUEHANNA TRAIL, SELINSGROVE, PA 17870-9374
(570) 743-2323
(570) 743-2343
Mailing address
7 COURTYARD OFFICES, 1372 N. SUSQUEHANNA TRAIL, SELINSGROVE, PA 17870-9374
(570) 743-2323
(570) 743-2343

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS007127L
PA

Other

Enumeration date
11/08/2006
Last updated
07/09/2007
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