Healthcare Provider Details

I. General information

NPI: 1891607321
Provider Name (Legal Business Name): MIRJAM MELODY JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY JACOBSON

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W 110TH ST # 145
OVERLAND PARK KS
66210-2331
US

IV. Provider business mailing address

13101 W 133RD CT APT 7222
OVERLAND PARK KS
66213-5209
US

V. Phone/Fax

Practice location:
  • Phone: 316-390-7818
  • Fax:
Mailing address:
  • Phone: 316-390-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05358
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3582438953
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: