Provider Demographics
NPI:1356529507
Name:JACOBS, JANE (EDD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 616
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1813
Mailing Address - Country:US
Mailing Address - Phone:202-362-6693
Mailing Address - Fax:
Practice Address - Street 1:5225 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 616
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1813
Practice Address - Country:US
Practice Address - Phone:202-362-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
491984OtherMIN