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Individual

MRS. JOANNE L JACOBS

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
CCC SLP

Contact information

Practice address
818 NEWTOWN RD, VIRGINIA BEACH, VA 23462-1116
(757) 473-8016
(757) 473-3580
Mailing address
818 NEWTOWN RD, VIRGINIA BEACH, VA 23462-1116
(757) 473-8016
(757) 473-3580

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202001616
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
330087
ANTHEM BLUE CROSS
01
35062
OPTIMA
01
4980093
CAQH
05
4980093
VA
01
5990711
AETNA
01
6400313
UNITED HEALTH CARE
01
9116460
MEDICAID DME
VA
01
95324397
TRICARE CHAMPUS
Enumeration date
11/14/2005
Last updated
07/08/2007
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