Individual
JACOB MAUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. CF-SLP
Contact information
Practice address
350 S 8TH ST, LEBANON, OR 97355-2242
(541) 259-1221
Mailing address
2705 NW GARRYANNA DR APT 3, CORVALLIS, OR 97330-1389
(541) 435-0394
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016041
OR
Other
Enumeration date
06/30/2017
Last updated
06/30/2017
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