Provider Demographics
NPI:1356058432
Name:JACOBS, DONNA M (LSWAIC)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:JACOBS
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOULA PRACTITIONER
Mailing Address - Street 1:100 N HOWARD ST STE W
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:360-809-7141
Mailing Address - Fax:
Practice Address - Street 1:44 MT OLIVE CT
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-7447
Practice Address - Country:US
Practice Address - Phone:470-894-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WASC614025771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula