Provider Demographics
NPI:1437689718
Name:JACOB, LINDSAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:CALLANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY- SLP
Mailing Address - Street 1:10243 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2028
Mailing Address - Country:US
Mailing Address - Phone:414-604-7206
Mailing Address - Fax:
Practice Address - Street 1:10243 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2028
Practice Address - Country:US
Practice Address - Phone:414-604-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist