| Doctor Name: | CHAD A JAKUBOWSKI |
| NPI Number: | 1245620038 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | C1300409 |
| Business Practice Address: | 40722 State Route 154 Lisbon, OH - 444328500 |
| Business Phone Number: | 3304249573 |
| Business Fax Number: | 3304240877 |
| Mailing Address: | Po Box 429, LISBON |
| State: | OH |
| Postal Code: | 444320429 |
| Phone Number: | 3304249573 |
| Fax Number: | 3304240877 |
| NPI Enumeration Date: | 01/31/2015 |
| NPI Last Update Date: | 01/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C1300409 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |