Provider Demographics
NPI:1023487600
Name:JACOBSON, BRITTNEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:BRITTNEY
Other - Middle Name:
Other - Last Name:BOEHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:1320 4TH
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1104
Mailing Address - Country:US
Mailing Address - Phone:641-357-5056
Mailing Address - Fax:
Practice Address - Street 1:509 BUDDY HOLLY PLACE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1359
Practice Address - Country:US
Practice Address - Phone:641-357-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist