Provider Demographics
NPI:1699085910
Name:JAKOBE, JESSICA EVANS
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:EVANS
Last Name:JAKOBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TEBBUTT ROAD
Mailing Address - Street 2:P.O. BOX 260
Mailing Address - City:RAINBOW LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12976
Mailing Address - Country:US
Mailing Address - Phone:518-327-3184
Mailing Address - Fax:
Practice Address - Street 1:141 PETROVA AVE
Practice Address - Street 2:PETROVA ELEMENTARY
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983
Practice Address - Country:US
Practice Address - Phone:518-897-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist