Provider Demographics
NPI:1255853289
Name:JACOBS, JALISSA ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JALISSA
Middle Name:ANN
Last Name: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 1:2481 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4205
Mailing Address - Country:US
Mailing Address - Phone:724-859-7126
Mailing Address - Fax:
Practice Address - Street 1:2481 SUNSET LN
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4205
Practice Address - Country:US
Practice Address - Phone:724-859-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SL012367235Z00000X
PASL012367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist