Healthcare Provider Details

I. General information

NPI: 1528212099
Provider Name (Legal Business Name): SHERYL GAYLE JAKOBSEN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 S HOSMER ST SUITE A
TACOMA WA
98444-1819
US

IV. Provider business mailing address

8717 S HOSMER ST SUITE A
TACOMA WA
98444-1819
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-2727
  • Fax: 253-471-2730
Mailing address:
  • Phone: 253-471-2727
  • Fax: 253-471-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL 60121171
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: