Active NPI
Katrina Jacobs
- Developmental Therapist
- Chicago, IL
National Provider Identifier
1679271639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- 149011408
- Practice address
- 8138 S Vernon Ave
Chicago, IL 60619-4914 - Phone
- (773) 882-3235
- NPI assigned
- Feb 20, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | 149011408 | IL | Primary |
Addresses
Primary practice location
8138 S Vernon Ave
Chicago, IL 60619-4914
Mailing address
111 N Wabash Ave Ste 100
Chicago, IL 60602-1903
Phone (773) 882-3235
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 |
|---|---|---|---|
| 149011408 | IL | MD | Developmental Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676851200000",
"number": "1679271639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N WABASH AVE STE 100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606021903",
"telephone_number": "773-882-3235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8138 S VERNON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606194914",
"telephone_number": "773-882-3235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "KATRINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-20",
"last_updated": "2023-02-20",
"certification_date": "2023-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "149011408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.