Provider Demographics
NPI:1457534547
Name:JACOBS, MICHELE MARINKOVIC (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MARINKOVIC
Last Name:JACOBS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:MARINKOVIC
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4772 W LEX AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7807
Mailing Address - Country:US
Mailing Address - Phone:803-915-7351
Mailing Address - Fax:
Practice Address - Street 1:4815 N ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6185
Practice Address - Country:US
Practice Address - Phone:509-434-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ348020281Medicare UPIN