Provider Demographics
NPI:1386999621
Name:JACOBS, LAUREN J (SLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 SW 34TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6264
Mailing Address - Country:US
Mailing Address - Phone:480-577-6141
Mailing Address - Fax:
Practice Address - Street 1:10001 SW 34TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6264
Practice Address - Country:US
Practice Address - Phone:480-577-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33451235Z00000X
OR016689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist