| Doctor Name: | LAVONNE JACOBSON |
| NPI Number: | 1104017953 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CSAC |
| License Number: | |
| Business Practice Address: | 504 Lakeland Rd Shawano, WI - 541663836 |
| Business Phone Number: | 7155265547 |
| Business Fax Number: | 7155265542 |
| Mailing Address: | 504 Lakeland Rd, SHAWANO |
| State: | WI |
| Postal Code: | 541663836 |
| Phone Number: | 7155265547 |
| Fax Number: | 7155265542 |
| NPI Enumeration Date: | 08/07/2007 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |