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General NPI Number Information
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NPI Number | 1447520010
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Entity Type | Organization
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Legal Business Name | WENDY JACOBS, JD, PHD, PA
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Dates
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Enumeration Date | 01/12/2012
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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 | OWNER
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Name | DR. WENDY L JACOBS
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Credential | PH.D.
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Telephone | 941-402-7520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6367
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License Number State | FL
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