Provider Demographics
NPI:1649945528
Name:MCINTOSH, JAKOB
Entity type:Individual
Prefix:
First Name:JAKOB
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-3311
Mailing Address - Country:US
Mailing Address - Phone:904-647-1849
Mailing Address - Fax:904-647-2625
Practice Address - Street 1:9141 CYPRESS GREEN DR STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2006
Practice Address - Country:US
Practice Address - Phone:904-647-1849
Practice Address - Fax:904-647-2625
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician