Provider Demographics
NPI:1760607568
Name:JACOBS, REGINA A (MA CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1346
Mailing Address - Country:US
Mailing Address - Phone:484-571-7560
Mailing Address - Fax:484-571-7560
Practice Address - Street 1:240 EMERSON DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1346
Practice Address - Country:US
Practice Address - Phone:484-571-7560
Practice Address - Fax:484-571-7560
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010171300001OtherMA