Individual
MS. MADELINE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP, RN, BSN
Contact information
Practice address
13568 SE 97TH AVE STE 202, CLACKAMAS, OR 97015-6668
(503) 694-3381
(503) 386-3293
Mailing address
PO BOX 23993, TIGARD, OR 97281-3993
(503) 694-3381
(503) 386-3293
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
201504614RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201809753NP-PP
OR
Other
Enumeration date
10/29/2015
Last updated
12/03/2024
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