Provider Demographics
NPI:1477759033
Name:JACOBITTI, JOANNA BESS (MA,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:BESS
Last Name:JACOBITTI
Suffix:
Gender:F
Credentials:MA,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 GLENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-4440
Mailing Address - Country:US
Mailing Address - Phone:704-654-9354
Mailing Address - Fax:
Practice Address - Street 1:5113 GLENBRIER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-4440
Practice Address - Country:US
Practice Address - Phone:704-654-9354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist