Individual
JACOB ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS,SLP-CFY
Contact information
Practice address
2524 GLENN AVE, SIOUX CITY, IA 51106-2768
(712) 226-2253
Mailing address
22464 PARK LOOP, ONAWA, IA 51040-8528
(859) 979-2618
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
084584
IA
Other
Enumeration date
10/26/2016
Last updated
10/26/2016
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