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General NPI Number Information
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NPI Number | 1588435788
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Entity Type | Individual
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Provider Name | AMANDA JO JACOBSON MS, LMFT-IT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 8A W DAVENPORT ST
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City | RHINELANDER
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State | WI
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Zip | 54501-3467
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Country | US
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Telephone | 715-490-5965
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Fax |
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Provider Business Mailing Address
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Address Line | 4694 BAYVIEW DR
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City | RHINELANDER
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State | WI
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Zip | 54501-7616
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Country | US
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Telephone | 715-490-5965
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1077-228
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License Number State | WI
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