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General NPI Number Information
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NPI Number | 1982515003
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Entity Type | Individual
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Provider Name | INDIA JACOBSON
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Gender | Female
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 2211 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3351
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Country | US
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Telephone | 773-466-6922
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Fax | 813-518-7659
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Provider Business Mailing Address
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Address Line | 2211 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3351
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Country | US
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Telephone | 773-466-6922
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Fax | 813-518-7659
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | 213000348
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 211000318
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License Number State | IL
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