Provider Demographics
NPI:1841423845
Name:JACOBS, ANNE KATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:KATHERINE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S SANTA FE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6210
Mailing Address - Country:US
Mailing Address - Phone:405-596-0360
Mailing Address - Fax:
Practice Address - Street 1:515 S SANTA FE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6210
Practice Address - Country:US
Practice Address - Phone:405-596-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK981103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent