Basic Information
| Provider Information | |||||||||
| NPI: | 1053903914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOPER | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9576 EVANESCENT WAY APT 1312 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328365534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407042222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 841 W MARION RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT GILEAD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433381031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199472015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2021 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP.11243 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.