Provider Demographics
NPI:1205012911
Name:JACOBS, COURTNEY EDMUNDS (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:EDMUNDS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WEST FORSYTH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3465
Mailing Address - Country:US
Mailing Address - Phone:229-928-8202
Mailing Address - Fax:229-928-8205
Practice Address - Street 1:511 W FORSYTH ST
Practice Address - Street 2:SUITE E
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3433
Practice Address - Country:US
Practice Address - Phone:229-928-8202
Practice Address - Fax:229-928-8205
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist