Provider Demographics
NPI:1598567208
Name:JACOBI, KELLY (LPMT, MT-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JACOBI
Suffix:
Gender:
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E KENILWORTH AVE UNIT 309
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6445
Mailing Address - Country:US
Mailing Address - Phone:224-213-0568
Mailing Address - Fax:
Practice Address - Street 1:909 E KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6467
Practice Address - Country:US
Practice Address - Phone:224-213-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL144.5225A00000X
PA17273225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist