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General NPI Number Information
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NPI Number | 1598567208
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Entity Type | Individual
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Provider Name | KELLY JACOBI LPMT, MT-BC
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Gender |
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 909 E KENILWORTH AVE
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City | PALATINE
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State | IL
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Zip | 60074-6467
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Country | US
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Telephone | 224-213-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 909 E KENILWORTH AVE UNIT 309
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City | PALATINE
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State | IL
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Zip | 60074-6445
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Country | US
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Telephone | 224-213-0568
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 144.5
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 17273
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License Number State | PA
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