Active NPI
Candice Lee Jacobs, CDC I
- Addiction (Substance Use Disorder) Counselor
- Kodiak, AK
National Provider Identifier
1609432004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 3449 E Rezanof Dr
Kodiak, AK 99615-6952 - Phone
- (907) 486-9800
- NPI assigned
- May 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | AK | Primary |
Addresses
Primary practice location
3449 E Rezanof Dr
Kodiak, AK 99615-6952
Mailing address
3449 E Rezanof Dr
Kodiak, AK 99615-6952
Phone (907) 486-9800
Other practice location 1
1318 Alaska Highway
Tok, AK 99780
Phone (907) 486-9800 ext. 2669
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | candice.jacobs@kodiakhealthcare.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658275200000",
"number": "1609432004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3449 E REZANOF DR",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156952",
"telephone_number": "907-486-9800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3449 E REZANOF DR",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156952",
"telephone_number": "907-486-9800"
}
],
"practiceLocations": [
{
"address_1": "1318 Alaska Highway",
"address_purpose": "LOCATION",
"city": "Tok",
"state": "AK",
"postal_code": "99780",
"country_code": "US",
"telephone_number": "907-486-9800 x2669",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBS",
"first_name": "CANDICE",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "CDC I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-13",
"last_updated": "2022-07-20",
"certification_date": "2022-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AK",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "candice.jacobs@kodiakhealthcare.org",
"affiliation": "N",
"endpointDescription": "Email",
"address_1": "3449 E Rezanof Dr",
"city": "Kodiak",
"state": "AK",
"country_code": "US",
"postal_code": "996156952",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kodiak, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.