Provider Demographics
NPI:1205457413
Name:BARBER, JACOB T (AUD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:T
Last Name:BARBER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 W SIMS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-3060
Mailing Address - Country:US
Mailing Address - Phone:360-379-5458
Mailing Address - Fax:
Practice Address - Street 1:19319 7TH AVE NE STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7442
Practice Address - Country:US
Practice Address - Phone:360-697-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD61055114231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist