Provider Demographics
NPI:1629869854
Name:UZZELL, JACOBB HADLEY
Entity type:Individual
Prefix:
First Name:JACOBB
Middle Name:HADLEY
Last Name:UZZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PENCE AVE
Mailing Address - Street 2:
Mailing Address - City:COTTAGE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:62018-1146
Mailing Address - Country:US
Mailing Address - Phone:618-980-8921
Mailing Address - Fax:
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:618-980-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians