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Individual

JACOB DANIEL BAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
SLP

Contact information

Practice address
626 TRAIL AVE, FREDERICK, MD 21701-4934
(301) 662-1997
(301) 668-2202
Mailing address
626 TRAIL AVE, FREDERICK, MD 21701-4934
(301) 662-1997
(301) 668-2202

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
07324
MD
235Z00000X
Speech-Language Pathologist
2202006812
VA
235Z00000X
Speech-Language Pathologist
SLP-1452
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
07324
STATE OF MARYLAND
MD
01
2202006812
COMMONWEALTH OF VIRGINIA
VA
01
SLP-1452
WEST VIRGINIA BOARDNOF EXAMINERS
WV
Enumeration date
07/24/2013
Last updated
07/24/2013
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