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Jacob Eugene Jacquez

Social Worker

Behavioral Health & Social Service Providers

PECOS Enrollment

This provider is enrolled in PECOS as JACOB JACQUEZ.

Based on the most recent information from CMS, provider Jacob Eugene Jacquez is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1841571353
Provider Type
Individual
Full Name
Jacquez, Jacob Eugene
Credential
LCSW

Gender
Male
Sole Proprietor
No
Enumeration Date
8/30/2011
Last Updated
12/6/2024

Contact Information

Practice Location

5814 S 900 E, Murray, UT 84121-1644

(385) 800-3272

(385) 800-3260

Mailing Location

5814 S 900 E, Murray, UT 84121-1644

(801) 548-9696

(385) 800-3260

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 7915180-3501 Utah
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License LCSW-871 Wyoming
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 0904013199 Virginia
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 4671239 Idaho

Provider Identifiers

ID	Description	Issuer
ID 1025579	Description Medicaid	Issuer Unlisted Utah

Jacob Eugene Jacquez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Ghimire, Aarati

Lewis, Michelle

Inner Purpose Counseling, Llc

Winter, Elaine Alice

Frey, Cristie

Barbara Scoville Llc

Tingey, Tenille

Barney, Geralynn

Hill, Rebekah

Wuthrich, Jamie Ann