Provider Demographics
NPI:1184218414
Name:KAISER, JACOB SCOTT
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:SCOTT
Last Name:KAISER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5009
Mailing Address - Country:US
Mailing Address - Phone:954-610-7060
Mailing Address - Fax:
Practice Address - Street 1:7120 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5009
Practice Address - Country:US
Practice Address - Phone:954-610-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL180571041C0700X
FLSW180571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical