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General NPI Number Information
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NPI Number | 1619352184
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Entity Type | Individual
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Provider Name | ALISON JACOBS
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Gender | Female
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 12630 W NORTH AVE BLDG E
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City | BROOKFIELD
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State | WI
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Zip | 53005-4626
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Country | US
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Telephone | 262-785-1008
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Fax | 262-432-9059
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Provider Business Mailing Address
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Address Line | 444 N WESTHILL BLVD
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City | APPLETON
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State | WI
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Zip | 54914-5715
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Country | US
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Telephone | 920-750-7000
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1931-226
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1931-226
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License Number State | WI
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