Provider Demographics
NPI:1376817296
Name:JACOB, MILI SARAH (MASLP)
Entity Type:Individual
Prefix:
First Name:MILI
Middle Name:SARAH
Last Name:JACOB
Suffix:
Gender:F
Credentials:MASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:MA
Mailing Address - Zip Code:01741-1245
Mailing Address - Country:US
Mailing Address - Phone:781-888-2829
Mailing Address - Fax:
Practice Address - Street 1:1135 NORTH RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:MA
Practice Address - Zip Code:01741-1245
Practice Address - Country:US
Practice Address - Phone:781-888-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MA8745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist