Provider Demographics
NPI:1972066173
Name:JACOBS, MADELINE (DO)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SE SANDY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2498
Mailing Address - Country:US
Mailing Address - Phone:971-265-6211
Mailing Address - Fax:
Practice Address - Street 1:975 SE SANDY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2498
Practice Address - Country:US
Practice Address - Phone:971-265-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A227112084P0800X
WAOP615122142084P0800X
ORDO2110402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry