Grace K Jacobson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP6492 Issued in MN

Practice address

1 12TH St Ste 208
Astoria, OR 97103-4146

Phone

(503) 470-1520

Fax

(503) 470-1191

NPI assigned

Dec 30, 2019

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 2, 2024 through Apr 2, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Courage Psychotherapy, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Astoria, OR
  • NPI 1396476883
  NPD Authorized official

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

{
    "created_epoch": "1577664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1750920443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 12TH ST STE 208",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971034146",
            "telephone_number": "503-470-1520",
            "fax_number": "503-470-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 12TH ST STE 208",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971034146",
            "telephone_number": "503-470-1520",
            "fax_number": "503-470-1191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "162 W Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Astoria",
            "state": "OR",
            "postal_code": "971036410",
            "country_code": "US",
            "telephone_number": "503-470-1520",
            "fax_number": "503-470-1191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "GRACE",
        "middle_name": "K",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-30",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP6492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Joseph Hurwitz, MD
• Ada E. E. Hutson
• Van Thi Bich Huynh
• Paul Innocenzi, PTA
• Jacquelyn Jacobsen
• James Chiropractic Spine and Joint Center LLC
• Joshua Tyler Jennings, MSW
• Jeremiah Shakespear DDS PC
• Lisa Ann Jimenez, PMHNP
• Hatai Jivagunchainan, DMD

• Clinical Psychologist in Astoria, OR
• Providers in Astoria, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.