Healthcare Provider Details

I. General information

NPI: 1972413771
Provider Name (Legal Business Name): DIANA LIZBEHT JACOBO SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 GREENWAY DR
IRVING TX
75038-2448
US

IV. Provider business mailing address

4778 HOVENKAMP DR
DALLAS TX
75227-2851
US

V. Phone/Fax

Practice location:
  • Phone: 877-688-2520
  • Fax:
Mailing address:
  • Phone: 877-688-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number45489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: