Provider Demographics
NPI:1710270434
Name:JACOB'S LADDER SPEECH AND LANGUAGE, PLLC
Entity Type:Organization
Organization Name:JACOB'S LADDER SPEECH AND LANGUAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:KALIHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-995-1321
Mailing Address - Street 1:3511 SKYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5990
Mailing Address - Country:US
Mailing Address - Phone:919-995-1321
Mailing Address - Fax:
Practice Address - Street 1:3511 SKYBROOK LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5990
Practice Address - Country:US
Practice Address - Phone:919-995-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty