| NPI | 1801108345 |
|---|---|
| Former Name | LISA NICHOLE JACOBSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2014-02-10 |