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General NPI Number Information
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NPI Number | 1174633242
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Entity Type | Individual
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Provider Name | WENDY LYNN JACOBS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 2650 BAHIA VISTA ST STE 201
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City | SARASOTA
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State | FL
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Zip | 34239-2625
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Country | US
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Telephone | 941-402-7520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17263
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City | SARASOTA
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State | FL
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Zip | 34276-0263
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Country | US
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Telephone | 941-402-7520
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY6367
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License Number State | FL
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