Basic Information
| Provider Information | |||||||||
| NPI: | 1619226008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | SONYA | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 PEREGRINE DR | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433012122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29 PLANTATION PARK DR | ||||||||
| Address2: | SUITE #403 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299109001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433156999 | ||||||||
| FaxNumber: | 8438156998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 08/31/2012 | ||||||||
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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 | 235Z00000X | 5101 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP007444 | GA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.