Healthcare Provider Details

I. General information

NPI: 1700094554
Provider Name (Legal Business Name): KATHERINE JAKISCHA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 HILLVIEW DR
PENSACOLA FL
32514-5436
US

IV. Provider business mailing address

20322 WILLIAMSBURG CT
CLEVELAND OH
44130-2449
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-5200
  • Fax:
Mailing address:
  • Phone: 440-915-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8343
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2041
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: