MEDICARE: JACOB WILHELM PLPC

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	101YP2500X	Professional Counselor	2018040841	MO

General Provider Information

NPI Number	:	1700449527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WILHELM PLPC

Provider Business Mailing Address
First Line	:	17 KIPLING WAY APT 101
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8137
Country	:	US
Telephone Number	:	417-214-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 N STADIUM BLVD FL 2
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1493
Country	:	US
Telephone Number	:	855-593-4349
Fax Number	:

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

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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