Provider Demographics
NPI:1326747486
Name:O'NEAL, JACOB CLAY
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CLAY
Last Name:O'NEAL
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 1:6139 W ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3461
Mailing Address - Country:US
Mailing Address - Phone:346-273-6396
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY STE 115
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6527
Practice Address - Country:US
Practice Address - Phone:763-200-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist