Active NPI
Haley Jacob
- Prevention Professional
- La Crosse, WI
National Provider Identifier
1659819076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 1901-39
- Practice address
- 1725 State St
126 Mitchell Hall
La Crosse, WI 54601-3742 - Phone
- (216) 978-1173
- NPI assigned
- Feb 6, 2017
- Last updated
- Feb 6, 2017
- 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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 1901-39 | WI | Primary |
Addresses
Primary practice location
1725 State St
126 Mitchell Hall
La Crosse, WI 54601-3742
Mailing address
18442 High Pkwy
Rocky River, OH 44116-2829
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1901-39 | WI | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486339200000",
"number": "1659819076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18442 HIGH PKWY",
"city": "ROCKY RIVER",
"state": "OH",
"postal_code": "441162829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 STATE ST",
"address_2": "126 MITCHELL HALL",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546013742",
"telephone_number": "216-978-1173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "HALEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-06",
"last_updated": "2017-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "WI",
"license": "1901-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.