Provider Demographics
NPI:1225474935
Name:JACOBS, LAURA ELIZABETH (MS CCC-SLP)
Entity Type:Individual
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First Name:LAURA
Middle Name:ELIZABETH
Last Name:JACOBS
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Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:2765 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8331
Mailing Address - Country:US
Mailing Address - Phone:540-720-2261
Mailing Address - Fax:540-720-5660
Practice Address - Street 1:13890 BRADDOCK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2435
Practice Address - Country:US
Practice Address - Phone:540-720-2261
Practice Address - Fax:540-720-5660
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
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Provider Licenses
StateLicense IDTaxonomies
VA2202006663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist