Individual
ADRIENNE L JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., B.C.B.A.
Contact information
Practice address
2035 W ILES AVE, SUITE C, SPRINGFIELD, IL 62704-4192
(217) 726-1946
Mailing address
6 ANNA LN, SPRINGFIELD, IL 62703-5303
(217) 971-8987
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-08-4191
IL
Other
Enumeration date
09/07/2012
Last updated
09/07/2012
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