Provider Demographics
NPI:1013215953
Name:JACOBS, CONNIE SUE (MS ED)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:KS
Mailing Address - Zip Code:67070-1911
Mailing Address - Country:US
Mailing Address - Phone:620-825-4228
Mailing Address - Fax:
Practice Address - Street 1:606 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1911
Practice Address - Country:US
Practice Address - Phone:620-825-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator