Individual
JACOB L ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
4560 SOUTH BLVD STE 310, VIRGINIA BEACH, VA 23452-1160
(757) 490-3223
Mailing address
400 WATERSIDE DR APT 301, NORFOLK, VA 23510-2114
(859) 979-2618
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
084584
IA
235Z00000X
Speech-Language Pathologist
Primary
2202011190
VA
Other
Enumeration date
10/26/2016
Last updated
06/29/2026
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