Provider Demographics
NPI:1053823237
Name:JACOB, LORRAINE ANNE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:ANNE
Last Name:JACOB
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19862 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5929
Mailing Address - Country:US
Mailing Address - Phone:714-222-3874
Mailing Address - Fax:
Practice Address - Street 1:19900 BASTANCHURY RD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-8417
Practice Address - Country:US
Practice Address - Phone:714-986-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist