Provider Demographics
NPI:1356830939
Name:JACOBS, JAMES N
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:JACOBS
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 1:7949 CRAWFORD FARMS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9255
Mailing Address - Country:US
Mailing Address - Phone:614-698-6469
Mailing Address - Fax:
Practice Address - Street 1:7949 CRAWFORD FARMS DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9255
Practice Address - Country:US
Practice Address - Phone:614-698-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid