Active NPI
Ellen Leota Jacobs, PH.D., SLP
- Speech-Language Pathologist
- Baker City, OR
National Provider Identifier
1104358050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12232
- Practice address
- 2704 2ND St
Baker City, OR 97814-2013 - Phone
- (541) 390-7376
- NPI assigned
- Mar 30, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12232 | OR | Primary |
Addresses
Primary practice location
2704 2ND St
Baker City, OR 97814-2013
Mailing address
2704 2ND St
Baker City, OR 97814-2013
Phone (541) 390-7376
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12232 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490832000000",
"number": "1104358050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2704 2ND ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978142013",
"telephone_number": "541-390-7376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2704 2ND ST",
"city": "BAKER CITY",
"state": "OR",
"postal_code": "978142013",
"telephone_number": "541-390-7376"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "ELLEN",
"middle_name": "LEOTA",
"name_prefix": "Dr.",
"credential": "PH.D., SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-30",
"last_updated": "2017-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "12232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baker City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.