Provider Demographics
NPI:1659158723
Name:CONCIENNE, JACOB DANIEL
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:CONCIENNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 CHURN CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2535
Mailing Address - Country:US
Mailing Address - Phone:530-221-7380
Mailing Address - Fax:530-221-7319
Practice Address - Street 1:3328 CHURN CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2535
Practice Address - Country:US
Practice Address - Phone:530-221-7380
Practice Address - Fax:530-221-7319
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8885237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist