Healthcare Provider Details

I. General information

NPI: 1295650745
Provider Name (Legal Business Name): JAKOB HOLMAN MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 UNIVERSITY AVE
BERKELEY CA
94702-1766
US

IV. Provider business mailing address

4114 39TH AVE
OAKLAND CA
94619-2206
US

V. Phone/Fax

Practice location:
  • Phone: 614-390-0977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: