K.a. Jacobson, PH.D., PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

LP0158 Issued in MN

Legal business name

K.A. JACOBSON, PH.D., PLLC

Practice address

5101 Olson Memorial Hwy
Suite 4003
Golden Valley, MN 55422-5149

Phone

(763) 595-7294

Fax

(763) 595-7293

NPI assigned

Jun 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kathleen A. Jacobson, PH.D.

Title

Clinical Psychologist

Phone

(763) 595-7294

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Malory Lyn Kaitter, MSW, LICSW

  • Clinical Social Worker
  • Golden Valley, MN
  • NPI 1093303026

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154363414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 OLSON MEMORIAL HWY",
            "address_2": "SUITE 4003",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225149",
            "telephone_number": "763-595-7294",
            "fax_number": "763-595-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 OLSON MEMORIAL HWY",
            "address_2": "SUITE 4003",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225149",
            "telephone_number": "763-595-7294",
            "fax_number": "763-595-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K.A. JACOBSON, PH.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "763-595-7294",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "LP0158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Deane Reitz Joiner, PA-C
• Brian Jordan, DDS
• Joseph J. House Edd LP
• Joshua Jubril
• Karla Junker, PTA
• Jennifer L Kahn, LICSW
• Jessica Kahnke
• Kaire LLC
• Malory Lyn Kaitter, MSW, LICSW
• Kristine Marie Kalmoe, MA

• Mental Health Clinic/Center (Including Community Mental Health Center) in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.