Provider Demographics
NPI:1598835563
Name:JACOBS, LILA G
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:G
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 EASTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-0028
Mailing Address - Country:US
Mailing Address - Phone:815-922-1218
Mailing Address - Fax:
Practice Address - Street 1:1095 PINGREE RD
Practice Address - Street 2:SUITE 119
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-1725
Practice Address - Country:US
Practice Address - Phone:847-458-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist