Provider Demographics
NPI:1053903914
Name:HOOPER, JACOB L (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:L
Last Name:HOOPER
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9576 EVANESCENT WAY APT 1312
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5534
Mailing Address - Country:US
Mailing Address - Phone:740-704-2222
Mailing Address - Fax:
Practice Address - Street 1:841 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1031
Practice Address - Country:US
Practice Address - Phone:419-947-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist