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General NPI Number Information
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NPI Number | 1700421302
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Entity Type | Individual
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Provider Name | MOLLY JACOBSON CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 2064 WOODBURY AVE STE 204
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City | NEWINGTON
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State | NH
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Zip | 03801-2808
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Country | US
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Telephone | 603-433-4192
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Fax | 603-433-3381
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Provider Business Mailing Address
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Address Line | 2064 WOODBURY AVE STE 204
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City | NEWINGTON
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State | NH
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Zip | 03801-2808
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Country | US
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Telephone | 603-433-4192
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Fax | 603-433-3381
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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 | 1947
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License Number State | NH
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