MEDICARE: SKYLAR JACOBSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1013875384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR JACOBSEN

Provider Business Mailing Address
First Line	:	343 W BAGLEY RD
Second Line	:
City	:	BEREA
State	:	OH
Zip	:	44017-1370
Country	:	US
Telephone Number	:	440-260-6835
Fax Number	:

Provider Business Practice Location Address
First Line	:	4579 EVERHARD RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2425
Country	:	US
Telephone Number	:	440-260-6835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ SKYLAR JACOBSEN ” Practice Location

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