Provider Demographics
NPI:1093382673
Name:DAVIS, JACOBI (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACOBI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JACOBI
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:3132 MATLOCK ROAD
Mailing Address - Street 2:STE 303
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015
Mailing Address - Country:US
Mailing Address - Phone:817-472-7720
Mailing Address - Fax:817-417-7280
Practice Address - Street 1:4550 SWEETWATER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3477
Practice Address - Country:US
Practice Address - Phone:281-277-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81394231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist