Provider Demographics
NPI:1578158135
Name:ROBERTS, JAKIEA LASHAY
Entity Type:Individual
Prefix:
First Name:JAKIEA
Middle Name:LASHAY
Last Name:ROBERTS
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 1:2445 SAILBOAT CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5900
Mailing Address - Country:US
Mailing Address - Phone:209-818-6284
Mailing Address - Fax:
Practice Address - Street 1:2445 SAILBOAT CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-5900
Practice Address - Country:US
Practice Address - Phone:209-818-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician