Jacobs, Liesl Jade
Jacobs, Liesl Jade is an individual health care provider with primary practice located at 5350 Lamme Rd , Moraine OH 45439-3215. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Jacobs, Liesl Jade can be contacted via phone (937) 534-4651.Contact Information
Primary practice address
5350 Lamme Rd
Moraine OH 45439-3215
Phone: (937) 534-4651
Fax: (937) 534-4669
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 35.097603 | Ohio |
Profile Details
| NPI number | 1063611853 |
|---|---|
| LBN Legal business name | Jacobs, Liesl Jade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2007 |
| Last updated | May 7th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063611853 | NPPES |
| Ohio | MEDICAID | 0067987 | |
| Ohio | Other | QMP000004762758 | |
| Ohio | Other | 000000915098 |
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