Provider Demographics
NPI:1912687518
Name:JACOBSON, MARY ABIGAIL (MPA, NBC-HWC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ABIGAIL
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MPA, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 SW GEMINI DR # 58509
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7105
Mailing Address - Country:US
Mailing Address - Phone:800-516-0975
Mailing Address - Fax:
Practice Address - Street 1:9450 SW GEMINI DR # 58509
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7105
Practice Address - Country:US
Practice Address - Phone:800-516-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselor