Provider Demographics
NPI:1841339348
Name:JACOBS, ARLEEN GALE (SLP)
Entity type:Individual
Prefix:MRS
First Name:ARLEEN
Middle Name:GALE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHITE BIRCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3202
Mailing Address - Country:US
Mailing Address - Phone:203-794-6062
Mailing Address - Fax:203-794-7558
Practice Address - Street 1:1 WHITE BIRCH DRIVE
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-3202
Practice Address - Country:US
Practice Address - Phone:203-794-6062
Practice Address - Fax:203-794-7558
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist