Provider Demographics
NPI:1932240546
Name:JACOBS, JANE E (MS)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 116TH ST E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3543
Mailing Address - Country:US
Mailing Address - Phone:253-770-1157
Mailing Address - Fax:253-770-4990
Practice Address - Street 1:10116 116TH ST E
Practice Address - Street 2:SUITE 202
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3543
Practice Address - Country:US
Practice Address - Phone:253-770-1157
Practice Address - Fax:253-770-4990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health