Provider Demographics
NPI:1427298819
Name:JACOBSON, LOUISE G (RD, CDE)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:G
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 POPLAR WOODS CIR S
Mailing Address - Street 2:# 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-0640
Mailing Address - Country:US
Mailing Address - Phone:901-755-6785
Mailing Address - Fax:
Practice Address - Street 1:6567 POPLAR WOODS CIR S
Practice Address - Street 2:# 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-0640
Practice Address - Country:US
Practice Address - Phone:901-755-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN412128133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered