MEDICARE: JAYNE ESTHER JACOBS MM, MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	102X00000X	Poetry Therapist
3	225A00000X	Music Therapist
4	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1760181804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYNE ESTHER JACOBS MM, MT-BC

Provider Business Mailing Address
First Line	:	2900 RIDGECREST DR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-4620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 S CENTER ST FL 3
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2537
Country	:	US
Telephone Number	:	307-315-8525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	03/06/2023

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