Provider Demographics
NPI:1366198111
Name:JACOBSON, ABBY NOMA (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:NOMA
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 NW 144TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-7516
Mailing Address - Country:US
Mailing Address - Phone:863-398-6606
Mailing Address - Fax:
Practice Address - Street 1:6700 NW 10TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4213
Practice Address - Country:US
Practice Address - Phone:352-331-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist