Provider Demographics
NPI:1295184828
Name:JAKUBOWICH, SOPHIE A (AUD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:A
Last Name:JAKUBOWICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3787
Mailing Address - Country:US
Mailing Address - Phone:214-923-7921
Mailing Address - Fax:
Practice Address - Street 1:11970 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3787
Practice Address - Country:US
Practice Address - Phone:214-382-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-04
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001622231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist