Provider Demographics
NPI:1922457779
Name:JARZABEK, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:JARZABEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11025 S 51ST ST APT 2003
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1756
Mailing Address - Country:US
Mailing Address - Phone:480-708-0795
Mailing Address - Fax:
Practice Address - Street 1:11025 S 51ST ST
Practice Address - Street 2:#2003
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1728
Practice Address - Country:US
Practice Address - Phone:480-708-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA97072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant