Individual
MRS. LARA ILYSSE JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
23 HOFFMAN ST, MAPLEWOOD, NJ 07040-1113
(212) 851-6231
Mailing address
23 HOFFMAN ST, MAPLEWOOD, NJ 07040-1113
(212) 851-6231
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
41YS00600100
NJ
Other
Enumeration date
09/27/2016
Last updated
09/27/2016
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