Provider Demographics
NPI:1750453809
Name:JAKOSALEM, CLAIRE SHANLEN TAGAB
Entity Type:Individual
Prefix:
First Name:CLAIRE SHANLEN
Middle Name:TAGAB
Last Name:JAKOSALEM
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 1:6181 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2002
Mailing Address - Country:US
Mailing Address - Phone:415-337-0140
Mailing Address - Fax:
Practice Address - Street 1:6181 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2002
Practice Address - Country:US
Practice Address - Phone:415-337-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor