Provider Demographics
NPI:1902263957
Name:MORAR-JACOBS, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MORAR-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 1:556 GENE BLAND RD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-3909
Mailing Address - Country:US
Mailing Address - Phone:912-294-6831
Mailing Address - Fax:
Practice Address - Street 1:556 GENE BLAND RD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-3909
Practice Address - Country:US
Practice Address - Phone:912-294-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist