Provider Demographics
NPI:1528374865
Name:FRITZ, JACOB EVAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:EVAN
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CREST AVE
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-1014
Mailing Address - Country:US
Mailing Address - Phone:606-782-5136
Mailing Address - Fax:
Practice Address - Street 1:117 CREST AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1014
Practice Address - Country:US
Practice Address - Phone:606-782-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist