Provider Demographics
NPI:1114180114
Name:JAKOB, JACQUELINE BALTIERRA (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BALTIERRA
Last Name:JAKOB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:BALTIERRA
Other - Last Name:JAKOB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:5675 TELEGRAPH RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1570
Mailing Address - Country:US
Mailing Address - Phone:323-838-9566
Mailing Address - Fax:323-838-9573
Practice Address - Street 1:5675 TELEGRAPH RD
Practice Address - Street 2:SUITE 260
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1570
Practice Address - Country:US
Practice Address - Phone:323-838-9566
Practice Address - Fax:323-838-9573
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW 23726OtherBOARD OF BEHAVIORAL SCIENCES