Individual
MARY JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SW,SAC-IT
Contact information
Practice address
300 4TH ST N, LA CROSSE, WI 54601-3228
(608) 784-4357
(608) 785-6122
Mailing address
300 4TH ST N, LA CROSSE, WI 54601-3228
(608) 784-4357
(608) 785-6122
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19001-130
WI
Other
Enumeration date
06/25/2020
Last updated
06/25/2020
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