MEDICARE: FRANCIS M. JACOBSON L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LP2936	MN

General Provider Information

NPI Number	:	1235282732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCIS M. JACOBSON L.P.

Provider Business Mailing Address
First Line	:	1311 E MINNESOTA AVE
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-1763
Country	:	US
Telephone Number	:	218-739-4797
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 EAST ALCOTT AVENUE
Second Line	:	LAKELAND MENTAL HEALTH CENTER
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-2999
Country	:	US
Telephone Number	:	218-736-6987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/08/2007

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