Provider Demographics
NPI:1093878480
Name:JACOBS, KAREN ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:JACOBS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 PLAINFIELD AVE NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1009
Mailing Address - Country:US
Mailing Address - Phone:616-365-1979
Mailing Address - Fax:616-365-1964
Practice Address - Street 1:5344 PLAINFIELD AVE NE
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1009
Practice Address - Country:US
Practice Address - Phone:616-365-1979
Practice Address - Fax:616-365-1964
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000001231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI903499018Medicaid
MI804687934Medicaid
MI640 D1 2604OtherBLUE CROSS BLUE SHIELD
MIOM65790Medicare ID - Type Unspecified