Individual
MR. JAKE HEATH JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATR, LCSW
Contact information
Practice address
6124 SE MILWAUKIE AVE, PORTLAND, OR 97202-5347
(347) 449-4565
Mailing address
6124 SE MILWAUKIE AVE, PORTLAND, OR 97202-5347
(347) 449-4565
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
069903
NY
1041C0700X
Clinical Social Worker
069903-1
NY
1041C0700X
Clinical Social Worker
Primary
L6016
OR
Other
Enumeration date
06/11/2009
Last updated
09/22/2014
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