Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 0345 | KS |
NPI | 1154303659 |
---|---|
Provider Name | Amy Marie Jacobs |
First Address | Wichita, KS 67206-2927 |
Second Address | Wichita, KS 67206-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 08/07/2007 |