MEDICARE: SHANNON JACOBSON CCC-SLP

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	235Z00000X	Speech-Language Pathologist	111994	TX

General Provider Information

NPI Number	:	1447999099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON JACOBSON CCC-SLP

Provider Business Mailing Address
First Line	:	2710 EADO GROVE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77003-1159
Country	:	US
Telephone Number	:	281-732-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3871 HOLMAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004
Country	:	US
Telephone Number	:	713-743-0915
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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Directions to “ SHANNON JACOBSON CCC-SLP” Practice Location

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