Provider Demographics
NPI:1457333791
Name:JACOBS, JOANNE L (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1116
Mailing Address - Country:US
Mailing Address - Phone:757-473-8016
Mailing Address - Fax:757-473-3580
Practice Address - Street 1:818 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1116
Practice Address - Country:US
Practice Address - Phone:757-473-8016
Practice Address - Fax:757-473-3580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
330087OtherANTHEM BLUE CROSS
35062OtherOPTIMA
VA9116460OtherMEDICAID DME
5990711OtherAETNA
4980093OtherCAQH
4980093OtherVIRGINIA PREMIER HEALTH P
VA4980093Medicaid
6400313OtherUNITED HEALTH CARE
95324397OtherTRICARE CHAMPUS
VA9116460OtherMEDICAID DME