Individual
LISA A JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W OTTLEY AVE, FRUITA, CO 81521-2118
(970) 858-2147
Mailing address
945 21 RD, FRUITA, CO 81521-9318
(970) 250-4432
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14129560
CO
Other
Enumeration date
12/02/2021
Last updated
12/02/2021
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