Provider Demographics
NPI:1821411604
Name:ERIN JACOBSON-KASLER, LLC
Entity Type:Organization
Organization Name:ERIN JACOBSON-KASLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON-KASLER
Authorized Official - Suffix:
Authorized Official - Credentials:MN, ARNP
Authorized Official - Phone:253-228-1490
Mailing Address - Street 1:PO BOX 7358
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0358
Mailing Address - Country:US
Mailing Address - Phone:253-983-8507
Mailing Address - Fax:
Practice Address - Street 1:6212 75TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8368
Practice Address - Country:US
Practice Address - Phone:253-983-8507
Practice Address - Fax:253-983-8576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004784261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health