Provider Demographics
NPI:1629565429
Name:GIDDINGS, JACOB ROCKWELL (HEARING SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ROCKWELL
Last Name:GIDDINGS
Suffix:
Gender:M
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16875 LANDING LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2609
Mailing Address - Country:US
Mailing Address - Phone:616-502-0916
Mailing Address - Fax:
Practice Address - Street 1:16875 LANDING LN
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2609
Practice Address - Country:US
Practice Address - Phone:616-502-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501007851237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist