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Individual
JACOB EUGENE JACQUEZ
Active
Individual
JACOB EUGENE JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904013199
VA
1041C0700X
Clinical Social Worker
4671239
ID
1041C0700X
Clinical Social Worker
Primary
7915180-3501
UT
1041C0700X
Clinical Social Worker
LCSW-871
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025579
—
UT
Enumeration date
08/30/2011
Last updated
12/06/2024
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