Provider Demographics
NPI:1619238946
Name:JACOB, SHERYL M
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:M
Last Name:JACOB
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 1:9109 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128-4903
Mailing Address - Country:US
Mailing Address - Phone:405-265-1655
Mailing Address - Fax:
Practice Address - Street 1:351 N AIR DEPOT BLVD STE M
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1760
Practice Address - Country:US
Practice Address - Phone:405-610-3644
Practice Address - Fax:405-610-3647
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor