Provider Demographics
NPI:1861601601
Name:JACOBSON, VERONICA RENEE (MM, NMT, MT-BC)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:RENEE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MM, NMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48554
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-0554
Mailing Address - Country:US
Mailing Address - Phone:612-807-3091
Mailing Address - Fax:
Practice Address - Street 1:2041 W OLD SHAKOPEE RD APT 40
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3036
Practice Address - Country:US
Practice Address - Phone:612-807-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist