Provider Demographics
NPI:1932277589
Name:JACOBS, RALPH A (PA DEPARTMENT OF HEA)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:PA DEPARTMENT OF HEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARK HILLS PLAZA
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-844-8156
Mailing Address - Fax:814-946-3059
Practice Address - Street 1:PARK HILLS PLAZA
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-8156
Practice Address - Fax:814-946-3059
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2762237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter