Healthcare Provider Details

I. General information

NPI: 1497631543
Provider Name (Legal Business Name): MR. JACOB DANIEL ZIEGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SUDBROOK LN STE A
BALTIMORE MD
21208-4184
US

IV. Provider business mailing address

712 RISINGHURST LN
OXFORD PA
19363-3314
US

V. Phone/Fax

Practice location:
  • Phone: 443-918-5575
  • Fax:
Mailing address:
  • Phone: 484-757-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03088L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: