Elaine Zeporah Jacobson, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1 Greencroft Dr
Champaign, IL 61821-5118

Phone

(217) 359-0691

Fax

(217) 359-0460

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386777167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GREENCROFT DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215118",
            "telephone_number": "217-359-0691",
            "fax_number": "217-359-0460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GREENCROFT DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215118",
            "telephone_number": "217-359-0691",
            "fax_number": "217-359-0460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "ELAINE",
        "middle_name": "ZEPORAH",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ariel Tarnisha Nicole Jackson
• Clint A Jackson, D.C.
• Jennifer Marie Jackson, RDH
• Susan Jackson, LCSW
• Laura Ann Jacob, R.D.
• Tejpalsinh Jadeja
• Ashok A Jagasia, MD
• Machete Jaguar
• Amy Marguerite Jahnel, MS, ATC
• Molly Brigid Jamen

• Psychologist in Champaign, IL
• Providers in Champaign, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.