Provider Demographics
NPI:1609193143
Name:JAKOBEIT, SHANDELL MARIE (HIS, COHC)
Entity Type:Individual
Prefix:MS
First Name:SHANDELL
Middle Name:MARIE
Last Name:JAKOBEIT
Suffix:
Gender:F
Credentials:HIS, COHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 LOEHR RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-6041
Mailing Address - Country:US
Mailing Address - Phone:979-247-4476
Mailing Address - Fax:
Practice Address - Street 1:932 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-3024
Practice Address - Country:US
Practice Address - Phone:979-968-3784
Practice Address - Fax:979-968-6613
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50691237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist