MEDICARE: SAMANTHA JACOBS

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	104100000X	Social Worker	11264	KS

General Provider Information

NPI Number	:	1518624592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JACOBS

Provider Business Mailing Address
First Line	:	3601 SW 29TH ST STE 127
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-2054
Country	:	US
Telephone Number	:	785-249-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 SW 29TH ST STE 127
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-2054
Country	:	US
Telephone Number	:	785-249-2569
Fax Number	:

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

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	11/24/2021

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Directions to “ SAMANTHA JACOBS ” Practice Location

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