Healthcare Provider Details

I. General information

NPI: 1134532245
Provider Name (Legal Business Name): AMY JACOBSON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 BEASER AVE
ASHLAND WI
54806-3604
US

IV. Provider business mailing address

1901 BEASER AVE
ASHLAND WI
54806-3604
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-9311
  • Fax: 715-682-9313
Mailing address:
  • Phone: 715-682-9311
  • Fax: 715-682-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number591-156
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number591-156
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number591-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: