| Doctor Name: | MRS. SANDRA JACOMET |
| NPI Number: | 1770982860 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | OK1000942 |
| Business Practice Address: | 4400 N Union Rd Trotwood, OH - 454263706 |
| Business Phone Number: | 9378544511 |
| Business Fax Number: | |
| Mailing Address: | 4400 N Union Rd, TROTWOOD |
| State: | OH |
| Postal Code: | 454263706 |
| Phone Number: | 9378544511 |
| Fax Number: | |
| NPI Enumeration Date: | 08/14/2014 |
| NPI Last Update Date: | 08/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | OK1000942 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |