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NPI Code Detail

MEDICARE: JAKELA WHITE

MEDICARE: JAKELA WHITE
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerLCSW136526CA
3171M00000XCase Manager/Care Coordinator
4390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1194207068
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKELA WHITE
Provider Business Mailing Address
First Line : PO BOX 110971
Second Line :
City : CAMPBELL
State : CA
Zip : 95011-0971
Country : US
Telephone Number : 515-290-3600
Fax Number :
Provider Business Practice Location Address
First Line : 251 LLEWELLYN AVE
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1940
Country : US
Telephone Number : 408-379-3790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 01/25/2026

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