Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LCS 19085 | CA |
NPI | 1003848599 |
---|---|
Provider Name | Ms. Melissa Charlynn Jacobs |
First Address | Sacramento, CA 95823-2501 |
Second Address | Sacramento, CA 95823-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 14/03/2014 |