MEDICARE: DR. AMY JACOBSON AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231HA2400X	Assistive Technology Practitioner Audiologist	591-156	WI
2	231HA2500X	Assistive Technology Supplier Audiologist	591-156	WI
3	231H00000X	Audiologist	591-156	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134532245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY JACOBSON AUD

Provider Business Mailing Address
First Line	:	1901 BEASER AVE
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-3604
Country	:	US
Telephone Number	:	715-682-9311
Fax Number	:	715-682-9313

Provider Business Practice Location Address
First Line	:	1901 BEASER AVE
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-3604
Country	:	US
Telephone Number	:	715-682-9311
Fax Number	:	715-682-9313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/26/2024

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