Provider Demographics
NPI:1518394261
Name:JACOBSON, WENDY JEAN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W PILOT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-7873
Mailing Address - Country:US
Mailing Address - Phone:661-204-9087
Mailing Address - Fax:
Practice Address - Street 1:2000 BAKER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-3061
Practice Address - Country:US
Practice Address - Phone:661-873-4927
Practice Address - Fax:661-873-4928
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)