Healthcare Provider Details

I. General information

NPI: 1699067066
Provider Name (Legal Business Name): JACOBS AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 LAUREL BOWIE RD STE 304
BOWIE MD
20715-1725
US

IV. Provider business mailing address

6915 LAUREL BOWIE RD STE 304
BOWIE MD
20715-1725
US

V. Phone/Fax

Practice location:
  • Phone: 301-860-1124
  • Fax: 240-929-4640
Mailing address:
  • Phone: 301-860-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: MS. MARCIA E JACOBS
Title or Position: AUDIOLOGIST
Credential: M.A.
Phone: 301-860-1124