Provider Demographics
NPI:1336398023
Name:JACOBSON, BEATRIZ VERA
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:VERA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N MOHAWK ST
Mailing Address - Street 2:SUITE #22
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5220
Mailing Address - Country:US
Mailing Address - Phone:773-677-3758
Mailing Address - Fax:312-787-3072
Practice Address - Street 1:1908 N MOHAWK ST
Practice Address - Street 2:SUITE #22
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5220
Practice Address - Country:US
Practice Address - Phone:773-677-3758
Practice Address - Fax:312-787-3072
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter