Provider Demographics
NPI:1982194999
Name:JACOBI, SANDRA LYNN (RBT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:JACOBI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RODENBURG RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1669
Mailing Address - Country:US
Mailing Address - Phone:630-632-7211
Mailing Address - Fax:
Practice Address - Street 1:30 RODENBURG RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1669
Practice Address - Country:US
Practice Address - Phone:630-632-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-18-50654106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician