MEDICARE: MS. LORETTA CLAIRE JACOBS MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14180833	MA

General Provider Information

NPI Number	:	1033675368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORETTA CLAIRE JACOBS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	42 WASHINGTON ST STE 110
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 WASHINGTON ST STE 110
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1817
Country	:	US
Telephone Number	:	800-804-5041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/12/2019

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