MEDICARE: ALISON JACOBS

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	101YM0800X	Mental Health Counselor	1931-226	WI
2	101YP2500X	Professional Counselor	1931-226	WI

General Provider Information

NPI Number	:	1619352184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON JACOBS

Provider Business Mailing Address
First Line	:	444 N WESTHILL BLVD
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-5715
Country	:	US
Telephone Number	:	920-750-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12630 W NORTH AVE BLDG E
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4626
Country	:	US
Telephone Number	:	262-785-1008
Fax Number	:	262-432-9059

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	09/05/2019

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Directions to “ ALISON JACOBS ” Practice Location

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