Provider Demographics
NPI:1871095604
Name:JACOBSON, HESTER HELENA
Entity type:Individual
Prefix:
First Name:HESTER
Middle Name:HELENA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 N RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49688-9604
Mailing Address - Country:US
Mailing Address - Phone:231-829-5116
Mailing Address - Fax:
Practice Address - Street 1:758 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-1395
Practice Address - Country:US
Practice Address - Phone:231-832-8707
Practice Address - Fax:231-832-9514
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist