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General NPI Number Information
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NPI Number | 1982779831
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Entity Type | Individual
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Provider Name | JON SCOTT JACOBS LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 408 RED CEDAR ST
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City | MENOMONIE
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State | WI
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Zip | 54751
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Country | US
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Telephone | 715-235-4696
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Fax | 715-235-3941
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Provider Business Mailing Address
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Address Line | M8898 250TH STREET
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City | SPRING VALLEY
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State | WI
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Zip | 54767
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Country | US
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Telephone | 715-778-4320
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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 | 397124
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License Number State | WI
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