ELLEN LOUISE JACOBSEN Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070001556

License Status

NOT RENEWED

Business

First Name

ELLEN LOUISE

Last Name

JACOBSEN

Business Name

ELLEN LOUISE JACOBSEN

Original Issue Date

03/28/1972

Effective Date

03/28/1972

City

HIGHLAND PARK

State

County

LAKE

Ever Disciplined

LastModifiedDate

10/14/2005