Provider Demographics
NPI:1699486993
Name:JACOBS, JACQUETTA MONTISE
Entity type:Individual
Prefix:
First Name:JACQUETTA
Middle Name:MONTISE
Last Name:JACOBS
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 1:206 KINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3834
Mailing Address - Country:US
Mailing Address - Phone:336-340-9135
Mailing Address - Fax:
Practice Address - Street 1:100 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6009
Practice Address - Country:US
Practice Address - Phone:336-472-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist