MEDICARE: DR. VANESSA JACOBY PH.D.

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	103TC0700X	Clinical Psychologist	37347	TX

General Provider Information

NPI Number	:	1952709875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA JACOBY PH.D.

Provider Business Mailing Address
First Line	:	7703 FLOYD CURL DR # 7792
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	254-449-3298
Fax Number	:

Provider Business Practice Location Address
First Line	:	3567 62ND & SANTA FE
Second Line	:
City	:	FT. HOOD
State	:	TX
Zip	:	76554-5005
Country	:	US
Telephone Number	:	254-288-8115
Fax Number	:

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

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	01/04/2018

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