Individual
LAURIE JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
24600 MILLSTREAM DR, SUITE 340, STONE RIDGE, VA 20105-5685
(703) 327-0335
Mailing address
20277 DAWSON MILL PL, LEESBURG, VA 20175-8807
(703) 407-3835
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202002736
VA
Other
Enumeration date
06/16/2016
Last updated
06/16/2016
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