Provider Demographics
NPI:1245639285
Name:JACOBSEN, JULIE A (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2802
Mailing Address - Country:US
Mailing Address - Phone:617-923-2255
Mailing Address - Fax:617-812-8016
Practice Address - Street 1:57 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472
Practice Address - Country:US
Practice Address - Phone:617-923-2255
Practice Address - Fax:617-812-8016
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3653133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered