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General NPI Number Information
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NPI Number | 1386167542
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Entity Type | Individual
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Provider Name | ANNE F. JACOBSON SPEECH PATHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/19/2017
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Provider Practice Location Address
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Address Line | 10 N SUMMIT AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-3310
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Country | US
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Telephone | 847-825-1161
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3314
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Country | US
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Telephone | 312-607-9556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146004746
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License Number State | IL
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