Provider Demographics
NPI:1275046633
Name:JAKUBOWSKI, KERI LYN
Entity Type:Individual
Prefix:
First Name:KERI LYN
Middle Name:
Last Name:JAKUBOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:JAKUBOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:589 STAFFORD AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4654
Mailing Address - Country:US
Mailing Address - Phone:262-309-7359
Mailing Address - Fax:
Practice Address - Street 1:589 STAFFORD AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4654
Practice Address - Country:US
Practice Address - Phone:262-309-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor