Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2370-125 | WI |
N | 101YS0200X | School Counselor | 173951 | WI |
NPI | 1154704559 |
---|---|
Provider Name | Mrs. Jill Jacobs |
First Address | Brookfield, WI 53005-5906 |
Second Address | Milwaukee, WI 53207-6159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42170300 | (05) | WI |