Individual
AMY P JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
110 W K ST, SHELTON, WA 98584-2944
(360) 426-1696
Mailing address
110 W K ST, SHELTON, WA 98584-2944
(360) 426-1696
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CGC60181519
WA
Other
Enumeration date
04/24/2007
Last updated
07/02/2024
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