ELLEN JACOBSEN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

ACTIVE

Business

First Name

ELLEN

Last Name

JACOBSEN

Suffix

Business Name

ELLEN JACOBSEN MD

Original Issue Date

12/09/1998

Effective Date

05/27/2023

Expiration Date

07/31/2026

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/27/2023