| Doctor Name: | KRISTIE CATALINA JACOBSON |
| NPI Number: | 1861658544 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CDPT |
| License Number: | RC00059629 |
| Business Practice Address: | 530 Bogachiel Way Forks, WA - 983319120 |
| Business Phone Number: | 3603745011 |
| Business Fax Number: | 3603746691 |
| Mailing Address: | 530 Bogachiel Way, FORKS |
| State: | WA |
| Postal Code: | 983319120 |
| Phone Number: | 3603745011 |
| Fax Number: | 3603746691 |
| NPI Enumeration Date: | 08/01/2008 |
| NPI Last Update Date: | 08/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RC00059629 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |