Provider Demographics
NPI:1801015391
Name:JACOBS, KATHERINE ANN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:KEEFER
Other - Last Name:OKLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30600 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3161
Mailing Address - Country:US
Mailing Address - Phone:248-788-1587
Mailing Address - Fax:248-539-7713
Practice Address - Street 1:30600 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3161
Practice Address - Country:US
Practice Address - Phone:248-788-1587
Practice Address - Fax:248-539-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006582103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical