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1801748579 NPI number — KATELYN MARENA JACOBSON M.S., CCC-SLP

NPI Number: 1801748579
Health Care Provider/Practitioner: KATELYN MARENA JACOBSON M.S., CCC-SLP

Information about “1801748579” NPI (KATELYN MARENA JACOBSON M.S., CCC-SLP) exists in 1801748579 in HTML format HTML  |  1801748579 in plain Text format TXT  |  1801748579 in PDF (Portable Document Format) PDF  |  1801748579 in an XML format XML  formats.

NPI Number : 1801748579 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801748579",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACOBSON",
    "FirstName": "KATELYN",
    "MiddleName": "MARENA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LORENZ",
    "OtherFirstName": "KATELYN",
    "OtherMiddleName": "MARENA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.S., CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "E4495 WOODLAND DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAU CLAIRE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54701-8569",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3000 STARR AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAU CLAIRE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54703-0916",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-852-3530",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/13/2026",
    "LastUpdateDate": "02/13/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "861687",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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