Provider Demographics
NPI:1962182824
Name:CREITZ, JACOB LEONARD
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:LEONARD
Last Name:CREITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4130
Mailing Address - Country:US
Mailing Address - Phone:410-358-1997
Mailing Address - Fax:
Practice Address - Street 1:1413 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6940
Practice Address - Country:US
Practice Address - Phone:410-751-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist