Provider Demographics
NPI:1649766171
Name:JACOBS, ISABEL ANNA (MA, SLP)
Entity type:Individual
Prefix:MRS
First Name:ISABEL
Middle Name:ANNA
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:MISS
Other - First Name:ISABEL
Other - Middle Name:ANNA
Other - Last Name:PAVLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2448
Mailing Address - Country:US
Mailing Address - Phone:201-403-5279
Mailing Address - Fax:
Practice Address - Street 1:501 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3621
Practice Address - Country:US
Practice Address - Phone:585-328-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027753-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist