Healthcare Provider Details

I. General information

NPI: 1154852093
Provider Name (Legal Business Name): BRITTANY JACOBSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 89TH ST STE 306
DALY CITY CA
94015-1656
US

IV. Provider business mailing address

295 89TH ST STE 306
DALY CITY CA
94015-1656
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 877-539-7730
Mailing address:
  • Phone: 877-264-6747
  • Fax: 877-539-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: