Healthcare Provider Details

I. General information

NPI: 1295649499
Provider Name (Legal Business Name): ALYSSA NICOLE JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 PACIFIC AVE STE 9
TACOMA WA
98408-7028
US

IV. Provider business mailing address

PO BOX 606
EATONVILLE WA
98328-0606
US

V. Phone/Fax

Practice location:
  • Phone: 509-321-7591
  • Fax:
Mailing address:
  • Phone: 253-341-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: