Individual
AMANDA LYNN JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
14201 W SUNRISE BLVD STE 107, SUNRISE, FL 33323-3207
(954) 756-2818
(954) 514-1126
Mailing address
14201 W SUNRISE BLVD STE 107, SUNRISE, FL 33323-3207
(954) 756-2818
(954) 514-1126
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA17265
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101048100
—
FL
01
—
SA17265
SPEECH LANGUAGE PATHOLOGIST
FL
Enumeration date
09/10/2018
Last updated
08/11/2020
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