Individual
MR. CHAD LAWRENCE JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
21907 64TH AVE W STE 200, MOUNTLAKE TERRACE, WA 98043-6200
(317) 695-8041
Mailing address
2619 BAKER AVE APT 1, EVERETT, WA 98201-3161
(317) 695-8041
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
11004760
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61025855
WA
Other
Enumeration date
10/29/2019
Last updated
11/15/2021
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