Madeline Jacobs, PMHNP, RN, BSN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201809753NP-PP Issued in OR

Practice address

13568 SE 97TH Ave Ste 202
Clackamas, OR 97015-6668

Phone

(503) 694-3381

Fax

(503) 386-3293

NPI assigned

Oct 29, 2015

Last updated

Dec 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacobs Mental Health Services

  dba Skycloud Mental Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Clackamas, OR
  • NPI 1407573850
  NPD Authorized official
• Jacobs MH of Washington

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Issaquah, WA
  • NPI 1033910450

  Psychiatric/Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1447622477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23993",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972813993",
            "telephone_number": "503-694-3381",
            "fax_number": "503-386-3293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13568 SE 97TH AVE STE 202",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156668",
            "telephone_number": "503-694-3381",
            "fax_number": "503-386-3293"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6700 SW 105th Ave Ste 203",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970088824",
            "country_code": "US",
            "telephone_number": "503-694-3381",
            "fax_number": "503-386-3293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7533 Center View Ct #210",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "84084",
            "country_code": "US",
            "telephone_number": "503-694-3381",
            "fax_number": "503-386-3293",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "MADELINE",
        "name_prefix": "Ms.",
        "credential": "PMHNP, RN, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-29",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201809753NP-PP",
            "primary": true
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "OR",
            "license": "201504614RN",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Elizabeth Jackson, PT, DPT
• Roxanne Marie Jackson, MSW, CSWA
• Sean Jackson
• Jacobs Mental Health Services (Skycloud Mental Health)
• Justin Jacobs
• Paul O. Jacobs, MD
• Alison Jane Jacobson
• Emily Young Choo Jacobson, RDH
• Jessica Sanchez Jacobson, M.S.
• Karin Thea Jacobson, MD

• Psychiatric/Mental Health Nurse Practitioner in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.