Jill K Jacobson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY60032612 Issued in WA

Practice address

1728 W Marine View Dr
Suite 106
Everett, WA 98201-2094

Phone

(425) 339-5453

Fax

(425) 252-4441

NPI assigned

Sep 23, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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

• Optum Care Washington PLLC

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
  • NPI 1154318103
  NPD (past)

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1679723050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOYT AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014918",
            "telephone_number": "425-259-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 W MARINE VIEW DR",
            "address_2": "SUITE 106",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982012094",
            "telephone_number": "425-339-5453",
            "fax_number": "425-252-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "JILL",
        "middle_name": "K",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY60032612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE LICENSE",
            "identifier": "PY60032612",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Lane Jacobs, BS
• Michelle Jacobs, D.O., MPH
• Debra Ann Jacobsen, LMT
• Judith Ann Jacobsen, MD
• Adalynn Jean Jacobson
• Robert Jacobson, MD
• Ronald Jay Jacobson, RN
• Jade W. Gan, DDS, PLLC
• Zahida Jaffer
• Sana Abbas Jaffri, M.D.

• Psychologist in Everett, WA
• Providers in Everett, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.