Provider Demographics
NPI:1861988594
Name:JACOBS, JORDAN L (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25589 BECKWITH RD
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3309
Mailing Address - Country:US
Mailing Address - Phone:315-405-5058
Mailing Address - Fax:
Practice Address - Street 1:26121 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3318
Practice Address - Country:US
Practice Address - Phone:315-221-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist