Provider Demographics
NPI:1992346480
Name:DONKIN, JACOB GLASER (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:GLASER
Last Name:DONKIN
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 OVERLEA RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2240
Mailing Address - Country:US
Mailing Address - Phone:301-922-1799
Mailing Address - Fax:
Practice Address - Street 1:1419 FOREST DR STE 206
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1473
Practice Address - Country:US
Practice Address - Phone:410-280-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01958L235Z00000X
MD09500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist