Provider Demographics
NPI:1245208388
Name:MILLER-JACOBS, KRISTINE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:MILLER-JACOBS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 117TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5189
Mailing Address - Country:US
Mailing Address - Phone:425-576-0820
Mailing Address - Fax:
Practice Address - Street 1:710 NW JUNIPER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2717
Practice Address - Country:US
Practice Address - Phone:425-392-4965
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2024-01-10
Deactivation Date:2022-09-21
Deactivation Code:
Reactivation Date:2024-01-10
Provider Licenses
StateLicense IDTaxonomies
WALL00002991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist