Provider Demographics
NPI:1699409045
Name:JACOBS, KAYLA ANN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
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 1:167 S 82ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8523
Mailing Address - Country:US
Mailing Address - Phone:319-239-9367
Mailing Address - Fax:
Practice Address - Street 1:217 E BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3435
Practice Address - Country:US
Practice Address - Phone:319-352-4544
Practice Address - Fax:319-352-4655
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist