Provider Demographics
NPI:1528212099
Name:JAKOBSEN, SHERYL GAYLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:GAYLE
Last Name:JAKOBSEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8717 S HOSMER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-1819
Mailing Address - Country:US
Mailing Address - Phone:253-471-2727
Mailing Address - Fax:253-471-2730
Practice Address - Street 1:8717 S HOSMER ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-1819
Practice Address - Country:US
Practice Address - Phone:253-471-2727
Practice Address - Fax:253-471-2730
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALL 60121171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist