Individual
JOSHUA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA II
Contact information
Practice address
4075 VALLEY RD, CLEVELAND, OH 44109-3072
(216) 313-1903
Mailing address
4075 VALLEY RD, CLEVELAND, OH 44109-3072
(216) 313-1903
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
543
—
OH
Enumeration date
04/26/2019
Last updated
04/26/2019
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