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General NPI Number Information
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NPI Number | 1811235906
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Entity Type | Individual
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Provider Name | MARK ANTHONY JACOBS M.S. CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 2205 TRAUTNER DR
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City | SAGINAW
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State | MI
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Zip | 48604-8201
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Country | US
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Telephone | 989-714-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 7315 BRANDON DR
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City | BAY CITY
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State | MI
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Zip | 48706-8323
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Country | US
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Telephone | 760-895-7770
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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 | 7101009852
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License Number State | MI
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