| Wr Jacobs Enterprises, Llc | |
|
806 Ne Lowell Dr Ankeny IA 50021-2090 | |
| (515) 509-0219 | |
| Not Available |
| Full Name | Wr Jacobs Enterprises, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 806 Ne Lowell Dr, Ankeny, Iowa |
| Authorized Official Name and Position | Warren R Jacobs (OWNER, LICENSED FAMILY THERAPIST) |
| Authorized Official Contact | 5155090219 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wr Jacobs Enterprises, Llc 806 Ne Lowell Dr Ankeny IA 50021-2090 Ph: (515) 509-0219 | Wr Jacobs Enterprises, Llc 806 Ne Lowell Dr Ankeny IA 50021-2090 Ph: (515) 509-0219 |
| NPI Number | 1104519065 |
|---|---|
| Provider Enumeration Date | 05/29/2023 |
| Last Update Date | 05/29/2023 |
| Certification Date | 05/27/2023 |
| Medicare PECOS PAC ID | 5991240947 |
|---|---|
| Medicare Enrollment ID | O20240715000178 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104519065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Warren H Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083705917 PECOS PAC ID: 3971505959 Enrollment ID: I20080512000614 |
| Provider Name | Robert A Doss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1851028971 PECOS PAC ID: 1658714662 Enrollment ID: I20240207000395 |
| Provider Name | Warren Rupert Jacobs |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1629530522 PECOS PAC ID: 7416284120 Enrollment ID: I20240715000212 |
| Provider Name | Hermina Kwangsa Tandia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871366468 PECOS PAC ID: 1153862677 Enrollment ID: I20240924000882 |
| Provider Name | Amanda L Bocock |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1831430628 PECOS PAC ID: 7315471232 Enrollment ID: I20241114000205 |
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