Healthcare Provider Details

I. General information

NPI: 1659492635
Provider Name (Legal Business Name): DR. CLAIRE JACOBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14607 SAN PEDRO SUITE 295
SAN ANTONIO TX
78232-4325
US

IV. Provider business mailing address

14607 SAN PEDRO, SUITE 295
SAN ANTONIO TX
78232-4325
US

V. Phone/Fax

Practice location:
  • Phone: 210-403-2050
  • Fax: 210-403-9890
Mailing address:
  • Phone: 210-403-2050
  • Fax: 210-403-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23850
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23850
License Number StateTX

VIII. Authorized Official

Name: MS. MEGAN RENEE OSTROM
Title or Position: PSYCHOLOGIST
Credential:
Phone: 210-403-2050