Provider Demographics
NPI:1811185994
Name:JACOBS, DIANE KAY
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:KAY
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 1:1694 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-1812
Mailing Address - Country:US
Mailing Address - Phone:717-755-8576
Mailing Address - Fax:
Practice Address - Street 1:1694 SAN GABRIEL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-1812
Practice Address - Country:US
Practice Address - Phone:717-755-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-14
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001678L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist