Individual provider Active NPI

Tiffany M Jacobsen, PSYD

  • Clinical Psychologist
  • Milwaukee, WI
National Provider Identifier
1821360199
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3720-57 Issued in WI
Practice address
2448 S 102ND St Ste 270
Milwaukee, WI 53227-2147
Phone
(414) 800-7645
Fax
(414) 800-7647
NPI assigned
Feb 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 3720-57 WI
Psychologist 103T00000X 3720-57 WI
Clinical Psychologist 103TC0700X 3720-57 WI Primary

Addresses

Primary practice location

2448 S 102ND St Ste 270
Milwaukee, WI 53227-2147

Mailing address

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005-5906
Phone (414) 800-7645

Other practice location 1

16535 W Bluemound Rd Ste 200
Brookfield, WI 53005-5906
Phone (262) 789-1191 ext. 150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191101000874 WI Practitioner - Clinical Psychologist 1254663792 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cornerstone Counseling Services IncGroup PAC ID 1456256023, 338 clinicians

Practice addresses (Care Compare)

16535 W Bluemound Rd
Suite 200
Brookfield, WI 53005-5906
Phone (262) 789-1191

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3720-57WIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc Mental Health CurrentSince Feb 2, 2022 Accepting new patients

Locations

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.tiffanyjacobsen@149809.advancedmd-direct.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1821360199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16535 W BLUEMOUND RD",
            "address_2": "STE 200",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530055906",
            "telephone_number": "414-800-7645",
            "fax_number": "414-800-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2448 S 102ND ST STE 270",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532272147",
            "telephone_number": "414-800-7645",
            "fax_number": "414-800-7647"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16535 W Bluemound Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Brookfield",
            "state": "WI",
            "postal_code": "530055906",
            "country_code": "US",
            "telephone_number": "262-789-1191 x150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "TIFFANY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-02",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "3720-57",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "3720-57",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3720-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.