Provider Demographics
NPI:1306667597
Name:JACOBSON, STEPHANIE DAWN (RDN LD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RDN LD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5357 HIGHWAY 175
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:IA
Mailing Address - Zip Code:51006-8603
Mailing Address - Country:US
Mailing Address - Phone:712-369-1742
Mailing Address - Fax:
Practice Address - Street 1:701 E 2ND ST
Practice Address - Street 2:
Practice Address - City:IDA GROVE
Practice Address - State:IA
Practice Address - Zip Code:51445-1699
Practice Address - Country:US
Practice Address - Phone:712-364-7298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered