MEDICARE: MS. ERIN JACOBSON LCPC, A.T.R.

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	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01-229	OTHER	IL	REGISTERED ART THERAPIST

General Provider Information

NPI Number	:	1497769038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN JACOBSON LCPC, A.T.R.

Provider Business Mailing Address
First Line	:	1944 WESLEY AVE
Second Line	:	1
City	:	BERWYN
State	:	IL
Zip	:	60402-1857
Country	:	US
Telephone Number	:	708-712-9255
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 HARRISON ST
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60304-1533
Country	:	US
Telephone Number	:	708-712-9255
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/25/2008

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