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General NPI Number Information
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NPI Number | 1013409895
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Entity Type | Individual
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Provider Name | ALISHA ANNE JACOBY M.ED, BCBA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 731 BIELENBERG DR STE 102
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City | WOODBURY
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State | MN
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Zip | 55125-1701
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Country | US
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Telephone | 612-445-8327
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Fax |
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Provider Business Mailing Address
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Address Line | 731 BIELENBERG DR STE 102
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City | WOODBURY
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State | MN
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Zip | 55125-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-25602
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License Number State | MN
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