Provider Demographics
NPI:1427448554
Name:JACOBSON, RACHEL JOY (CB-MT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JOY
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:CB-MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5006
Mailing Address - Country:US
Mailing Address - Phone:701-367-1524
Mailing Address - Fax:
Practice Address - Street 1:2702 26TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5006
Practice Address - Country:US
Practice Address - Phone:701-367-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist