MEDICARE: DR. LARA J. JAKOBSONS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071008778	IL

General Provider Information

NPI Number	:	1346664265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARA J. JAKOBSONS PH.D.

Provider Business Mailing Address
First Line	:	636 CHURCH ST STE 405
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4580
Country	:	US
Telephone Number	:	847-250-9959
Fax Number	:	847-306-8118

Provider Business Practice Location Address
First Line	:	636 CHURCH ST STE 405
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4580
Country	:	US
Telephone Number	:	847-250-9959
Fax Number	:	847-306-8113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	06/02/2025

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