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General NPI Number Information
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NPI Number | 1134626328
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Entity Type | Individual
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Provider Name | HEATHER JACOBS MPA, NBC-HWC
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 1919 NW LOVEJOY ST
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City | PORTLAND
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State | OR
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Zip | 97209-1503
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Country | US
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Telephone | 503-415-4753
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Fax |
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Provider Business Mailing Address
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Address Line | 3321 SE LOEFFELMAN RD
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City | MILWAUKIE
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State | OR
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Zip | 97222-7015
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Country | US
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Telephone | 831-239-8017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | A-3105172
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License Number State | OR
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