Provider Demographics
NPI:1598119125
Name:KLOET, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KLOET
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 1:3302 W SCHUBERT AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3302 W SCHUBERT AVE
Practice Address - Street 2:APT 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1324
Practice Address - Country:US
Practice Address - Phone:262-492-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional