Provider Demographics
NPI:1710338165
Name:JACOBS, ANNA COLLETTE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:COLLETTE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13730 E 14TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2510
Mailing Address - Country:US
Mailing Address - Phone:415-260-0057
Mailing Address - Fax:
Practice Address - Street 1:1000 SAN LEANDRO BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1598
Practice Address - Country:US
Practice Address - Phone:415-260-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker