Bruce Kenneth Jacobson, PH.D., P.C.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

450510082 Issued in UT

Practice address

4190 Highland Dr
Suite 211
Salt Lake City, UT 84124-2600

Phone

(801) 272-0614

NPI assigned

Feb 29, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Bruce K Jacobson PH D P C

  • Adult Mental Health Clinic/Center
  • Salt Lake City, UT
  • NPI 1417913575
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520985600000",
    "number": "1679743009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 HIGHLAND DR",
            "address_2": "SUITE 211",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242600",
            "telephone_number": "801-272-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 HIGHLAND DR",
            "address_2": "SUITE 211",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841242600",
            "telephone_number": "801-272-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "BRUCE",
        "middle_name": "KENNETH",
        "credential": "PH.D., P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-29",
        "last_updated": "2018-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "450510082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Ann Jacobsen, MS
• Jorgan Hoggan Jacobsen, PA-C
• Kelli Clark Jacobsen, LCSW
• Stephanie Dawn Jacobsen
• Kristin Jacobson Messner, SLP
• Bryanna Jacobson
• Carlene Jacobson, RN
• Deborah Lynn Jacobson, MD
• Hannah Qian Ying Jacobson
• Howard Scott Jacobson III

• Psychologist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.