MEDICARE: ALICIA JAKOMAIT

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	1041C0700X	Clinical Social Worker	006753	CT

General Provider Information

NPI Number	:	1477789592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA JAKOMAIT

Provider Business Mailing Address
First Line	:	313 N TEJON ST
Second Line	:	OFFICE15
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1243
Country	:	US
Telephone Number	:	719-321-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 N TEJON ST
Second Line	:	OFFICE15
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1243
Country	:	US
Telephone Number	:	719-321-5600
Fax Number	:

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

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	12/14/2010

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