Individual
KELSEY JO JACOBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP
Contact information
Practice address
6419 LAKEWOOD DR W, UNIVERSITY PLACE, WA 98467-3331
(253) 531-8873
(253) 854-7025
Mailing address
10811 SE KENT KANGLEY RD, KENT, WA 98030-7108
(253) 854-5660
(253) 854-7025
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL61423482
WA
235Z00000X
Speech-Language Pathologist
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2237671
—
WA
Enumeration date
03/14/2023
Last updated
03/23/2023
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