Provider Demographics
NPI:1518464536
Name:KEUP, JACOB (AUD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KEUP
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3154
Mailing Address - Country:US
Mailing Address - Phone:830-643-0033
Mailing Address - Fax:830-643-0350
Practice Address - Street 1:1340 WONDER WORLD DR STE 2300
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8070
Practice Address - Country:US
Practice Address - Phone:737-221-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80976231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist