Provider Demographics
NPI:1821438433
Name:JACOBS, JENA M I (BSW)
Entity Type:Individual
Prefix:MS
First Name:JENA
Middle Name:M
Last Name:JACOBS
Suffix:I
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:JENA
Other - Middle Name:M
Other - Last Name:JACOBS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:BHRS
Mailing Address - Street 1:3175 OLD GOLDEN HWY
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-6924
Mailing Address - Country:US
Mailing Address - Phone:580-420-6931
Mailing Address - Fax:
Practice Address - Street 1:303 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2047
Practice Address - Country:US
Practice Address - Phone:580-889-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker