Individual
GRACE K JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1 12TH ST STE 208, ASTORIA, OR 97103-4146
(503) 470-1520
(503) 470-1191
Mailing address
1 12TH ST STE 208, ASTORIA, OR 97103-4146
(503) 470-1520
(503) 470-1191
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6492
MN
Other
Enumeration date
12/30/2019
Last updated
01/09/2023
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