Provider Demographics
NPI:1457082430
Name:HUSE, KARA-LEIGH JACOBSEN (ATR-BC)
Entity Type:Individual
Prefix:
First Name:KARA-LEIGH
Middle Name:JACOBSEN
Last Name:HUSE
Suffix:
Gender:F
Credentials:ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16439 DAZA DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-4612
Mailing Address - Country:US
Mailing Address - Phone:626-833-5307
Mailing Address - Fax:
Practice Address - Street 1:16439 DAZA DR
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-4612
Practice Address - Country:US
Practice Address - Phone:626-833-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17-296221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist