Provider Demographics
NPI:1164033528
Name:JAKUBOVIC, KATELYN IRENE (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:IRENE
Last Name:JAKUBOVIC
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 DAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3026
Mailing Address - Country:US
Mailing Address - Phone:724-771-5810
Mailing Address - Fax:
Practice Address - Street 1:1119 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5201
Practice Address - Country:US
Practice Address - Phone:247-804-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012604101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor