Provider Demographics
NPI:1679593263
Name:HESSE, JACOB SCOTT (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:SCOTT
Last Name:HESSE
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 250TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IA
Mailing Address - Zip Code:50622-1043
Mailing Address - Country:US
Mailing Address - Phone:319-404-5720
Mailing Address - Fax:
Practice Address - Street 1:212 27TH ST.
Practice Address - Street 2:UNIVERSITY OF NORTHERN IOWA
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613
Practice Address - Country:US
Practice Address - Phone:319-415-9168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA003372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer