Basic Information
| Provider Information | |||||||||
| NPI: | 1477951143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBSON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 4TH AVE. | ||||||||
| Address2: | P.O. BOX 300 | ||||||||
| City: | SHELL LAKE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548710300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154687833 | ||||||||
| FaxNumber: | 7154687839 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 4TH AVE. | ||||||||
| Address2: | |||||||||
| City: | SHELL LAKE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154687833 | ||||||||
| FaxNumber: | 7154687839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2014 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 263328 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.