Provider Demographics
NPI:1871575266
Name:JACOBS, ASHLEY NICOLE (MS)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:819 GRANITE LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-7800
Mailing Address - Country:US
Mailing Address - Phone:912-656-8254
Mailing Address - Fax:
Practice Address - Street 1:819 GRANITE LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-7800
Practice Address - Country:US
Practice Address - Phone:912-656-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-19
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist