Provider Demographics
NPI:1689874141
Name:RAU, JACOB GOLDEN (BS)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:GOLDEN
Last Name:RAU
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61324 BLAKELY RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2270
Mailing Address - Country:US
Mailing Address - Phone:541-385-7978
Mailing Address - Fax:
Practice Address - Street 1:63360 BRITTA ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6869
Practice Address - Country:US
Practice Address - Phone:541-318-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor