Provider Demographics
NPI:1326224148
Name:JAKUBOWICZ, SHELLEY M
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:M
Last Name:JAKUBOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:JAKUBOWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:7335 MILESTRIP RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1410
Mailing Address - Country:US
Mailing Address - Phone:716-662-1150
Mailing Address - Fax:
Practice Address - Street 1:7335 MILESTRIP RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1410
Practice Address - Country:US
Practice Address - Phone:716-662-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004550-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist