Provider Demographics
NPI:1902044076
Name:JACOBS, DARA S (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1537
Mailing Address - Country:US
Mailing Address - Phone:847-204-1774
Mailing Address - Fax:
Practice Address - Street 1:15 SUNRIDGE LN
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1537
Practice Address - Country:US
Practice Address - Phone:847-204-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist