Kelly Jacobson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

41521 W 11 Mile Rd
Novi, MI 48375-1803

Phone

(248) 299-0030

NPI assigned

Apr 2, 2018

Last updated

Dec 12, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Beaverton, OR
  • NPI 1528066859
  NPD (past)
• Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1831054436
  NPD (past)

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1568968329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3236 SE HARVEY ST APT 6",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972226590",
            "telephone_number": "503-449-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41521 W 11 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483751803",
            "telephone_number": "248-299-0030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 NW Vaughn St Ste 360",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972105376",
            "country_code": "US",
            "telephone_number": "503-968-3487",
            "fax_number": "503-227-0676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "THW000002598",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aunique Jacobs
• Brigette Jacobs
• Kalonny M Jacobs
• Michael John Jacobs, MD
• Sarah J Jacobsen, LMSW
• Bianca Bushra Jaden
• Jean Anna Jaffke, M.D.
• Kelly Ann McGinity Jagers, LMSW LMFT
• Sunayana Jagtap
• Aneela Jahangir, RPT

• Behavior Technician in Novi, MI
• Providers in Novi, MI by specialty
• Behavior Technician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.