| Doctor Name: | DR. PAMELA JEAN JACOBSON |
| NPI Number: | 1255683066 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D., L.P. |
| License Number: | LP5828 |
| Business Practice Address: | 517 N 17th St Montevideo, MN - 562653067 |
| Business Phone Number: | 3202696581 |
| Business Fax Number: | 8555627905 |
| Mailing Address: | Po Box 787, WILLMAR |
| State: | MN |
| Postal Code: | 562010787 |
| Phone Number: | 3202354613 |
| Fax Number: | 8556257406 |
| NPI Enumeration Date: | 10/04/2012 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | LP5828 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |