Provider Demographics
NPI:1740954130
Name:FRANCEK, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:FRANCEK
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 1:2065 LEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-6593
Mailing Address - Country:US
Mailing Address - Phone:803-992-9182
Mailing Address - Fax:
Practice Address - Street 1:1420 EBENEZER RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2774
Practice Address - Country:US
Practice Address - Phone:803-818-3613
Practice Address - Fax:803-818-3613
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0693237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist