MEDICARE: JAIME JACOBS

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

General Provider Information

NPI Number	:	1689180861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME JACOBS

Provider Business Mailing Address
First Line	:	80 LAKE ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03060-4431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 LAKE ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03060-4431
Country	:	US
Telephone Number	:	603-881-4190
Fax Number	:

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

Provider Enumeration Date	:	12/24/2017
Last Update Date	:	03/17/2018

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Directions to “ JAIME JACOBS ” Practice Location

Language	Start Address	Practice Location

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