Jacob Jeffry Baczuk

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Practice address

1525 Lincoln Ave
Ogden, UT 84404-5638

Phone

(801) 706-6677

NPI assigned

May 2, 2019

Last updated

May 2, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1225693591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 LINCOLN AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045638",
            "telephone_number": "801-706-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 LINCOLN AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045638",
            "telephone_number": "801-706-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACZUK",
        "first_name": "JACOB",
        "middle_name": "JEFFRY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "870299862",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Ogden",
            "affiliation": "N",
            "address_1": "1525 Lincoln Ave",
            "city": "Ogden",
            "state": "UT",
            "country_code": "US",
            "postal_code": "844045638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kadie Jeanne Avis
• Yousef Mohammed Awad, MD
• Andrea Kirstin Bacani, M.D.
• Casey C Bachison, M.D.
• Alec Dean Backus
• Samantha CJ Baer
• Travis Scott Baer, L.C.S.W.
• Adam K Bagley, PA-C
• Ethan Patrick Baham, DO
• Valerie Marie Bahena

• Marriage & Family Therapist in Ogden, UT
• Providers in Ogden, UT by specialty
• Marriage & Family Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.