Provider Demographics
NPI:1215534425
Name:JACOBS, KATIE DAWN
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:DAWN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 FRONT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1244
Mailing Address - Country:US
Mailing Address - Phone:907-364-4565
Mailing Address - Fax:907-586-4237
Practice Address - Street 1:225 FRONT ST STE 202
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1244
Practice Address - Country:US
Practice Address - Phone:907-364-4565
Practice Address - Fax:907-586-4237
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty