Healthcare Provider Details

I. General information

NPI: 1376447268
Provider Name (Legal Business Name): VIRGINIA JACOBSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JINN JACOBSON SLP

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 CHURN CREEK RD
REDDING CA
96002-2798
US

IV. Provider business mailing address

2200 EUREKA WAY
REDDING CA
96001-0337
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-6601
  • Fax:
Mailing address:
  • Phone: 530-524-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP13239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: