Provider Demographics
NPI:1508814187
Name:JACOBY, ALICIA KATHERINE (LMP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KATHERINE
Last Name:JACOBY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:KATHERINE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1612 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665
Mailing Address - Country:US
Mailing Address - Phone:360-573-3223
Mailing Address - Fax:360-573-3224
Practice Address - Street 1:1612 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665
Practice Address - Country:US
Practice Address - Phone:360-573-3223
Practice Address - Fax:360-573-3224
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016071174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist