MEDICARE: LORI JACOBS

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

General Provider Information

NPI Number	:	1760869846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JACOBS

Provider Business Mailing Address
First Line	:	47636 327TH ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-6801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	829 E 29TH ST
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3345
Country	:	US
Telephone Number	:	402-494-0106
Fax Number	:

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

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	12/11/2015

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Directions to “ LORI JACOBS ” Practice Location

Language	Start Address	Practice Location

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