Provider Demographics
NPI:1386167542
Name:JACOBSON, ANNE F (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:F
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3314
Mailing Address - Country:US
Mailing Address - Phone:312-607-9556
Mailing Address - Fax:
Practice Address - Street 1:10 N SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3310
Practice Address - Country:US
Practice Address - Phone:847-825-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist