Healthcare Provider Details

I. General information

NPI: 1053232801
Provider Name (Legal Business Name): OLUSHOLA JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 LORD BALTIMORE DR STE 105
WINDSOR MILL MD
21244-5801
US

IV. Provider business mailing address

3104 LORD BALTIMORE DR STE 105
WINDSOR MILL MD
21244-5801
US

V. Phone/Fax

Practice location:
  • Phone: 410-725-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: