Provider Demographics
NPI:1245564228
Name:JACOBS-CONDIT, LINDA (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:JACOBS-CONDIT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GWU SPEECH & HEARING CTR
Mailing Address - Street 2:2115 G STREET NW, RM B-01
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20052-0001
Mailing Address - Country:US
Mailing Address - Phone:202-994-7360
Mailing Address - Fax:202-994-0747
Practice Address - Street 1:GWU SPEECH & HEARING CTR
Practice Address - Street 2:2115 G STREET NW, RM B-01
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0001
Practice Address - Country:US
Practice Address - Phone:202-994-7360
Practice Address - Fax:202-994-0747
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAUD000011231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC214831OtherMEDICARE PTAN