Provider Demographics
NPI:1013381128
Name:MARLOW, JACOB DANIEL (HID)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DANIEL
Last Name:MARLOW
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18649 N APACHE PATH
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9050
Mailing Address - Country:US
Mailing Address - Phone:309-684-0888
Mailing Address - Fax:309-662-3384
Practice Address - Street 1:2412 E WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4497
Practice Address - Country:US
Practice Address - Phone:309-662-0622
Practice Address - Fax:309-662-3384
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3215237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist