Provider Demographics
NPI:1083066658
Name:JACOBS, JULIA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5538
Mailing Address - Country:US
Mailing Address - Phone:612-871-1144
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:6099 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5538
Practice Address - Country:US
Practice Address - Phone:612-871-1144
Practice Address - Fax:817-920-0068
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist