Provider Demographics
NPI:1164848388
Name:JACOBS, CLAIRE (PHD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 METLAKATLA ST
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7666
Mailing Address - Country:US
Mailing Address - Phone:907-747-3636
Mailing Address - Fax:907-747-2702
Practice Address - Street 1:113 METLAKATLA ST
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7666
Practice Address - Country:US
Practice Address - Phone:907-747-3636
Practice Address - Fax:907-747-2702
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2357103TC0700X
AK157805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical