Provider Demographics
NPI:1669094538
Name:JACOBSON, JESSIE MAE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:MAE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 BRUNSWICK AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2914
Mailing Address - Country:US
Mailing Address - Phone:218-409-8759
Mailing Address - Fax:
Practice Address - Street 1:1536 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1205
Practice Address - Country:US
Practice Address - Phone:218-409-8759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer