Individual
JACOB WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
235 DUNLOP FARMS BLVD, COLONIAL HEIGHTS, VA 23834-1792
(804) 520-0050
Mailing address
4716 WILCONNA RD, CHESTERFIELD, VA 23832-7657
(804) 528-9784
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202007850
VA
Other
Enumeration date
04/01/2015
Last updated
08/31/2023
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