Basic Information
| Provider Information | |||||||||
| NPI: | 1518156876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAKAB | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6707 POWERS BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408424800 | ||||||||
| FaxNumber: | 4408424883 | ||||||||
| Practice Location | |||||||||
| Address1: | 6707 POWERS BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | PARMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441295455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408424800 | ||||||||
| FaxNumber: | 4408424883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | A01619 | OH | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.