Provider Demographics
NPI:1790883353
Name:JACOBS, DIANA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:P
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 BELLWETHER WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2914
Mailing Address - Country:US
Mailing Address - Phone:360-734-7310
Mailing Address - Fax:360-647-8336
Practice Address - Street 1:960 HARRIS AVE # 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7009
Practice Address - Country:US
Practice Address - Phone:360-734-7310
Practice Address - Fax:360-647-8336
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245761188OtherNPPES