Healthcare Provider Details

I. General information

NPI: 1619832938
Provider Name (Legal Business Name): EMILY LAURA JACOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S JACKSON ST
GREEN BAY WI
54301-3909
US

IV. Provider business mailing address

835 S JACKSON ST
GREEN BAY WI
54301-3515
US

V. Phone/Fax

Practice location:
  • Phone: 920-609-8169
  • Fax:
Mailing address:
  • Phone: 920-609-8169
  • Fax: 920-609-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: