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General NPI Number Information
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NPI Number | 1770718603
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Entity Type | Individual
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Provider Name | SUE L. JACOBS PHD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 16456 S FELLOWS ST
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City | OLATHE
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State | KS
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Zip | 66062-7862
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Country | US
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Telephone | 816-820-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 KING STREET
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City | OVERLAND PARK
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State | KS
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Zip | 66210
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Country | US
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Telephone | 913-642-3134
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Fax | 913-766-6037
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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