1205012911 NPI number — MRS. COURTNEY EDMUNDS JACOBS CCC-SLP

Table of content: MRS. COURTNEY EDMUNDS JACOBS CCC-SLP (NPI 1205012911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205012911 NPI number — MRS. COURTNEY EDMUNDS JACOBS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
COURTNEY
Provider Middle Name:
EDMUNDS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205012911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 WEST FORSYTH ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
AMERICUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31709-3465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-928-8202
Provider Business Mailing Address Fax Number:
229-928-8205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 W FORSYTH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
AMERICUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31709-3433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-928-8202
Provider Business Practice Location Address Fax Number:
229-928-8205
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP006018 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com