Provider Demographics
NPI:1033412051
Name:WHALEY, JENNIFER M (BC-HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WHALEY
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CYPRESS POINT PKWY STE A108
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164
Mailing Address - Country:US
Mailing Address - Phone:386-283-4932
Mailing Address - Fax:386-283-4934
Practice Address - Street 1:160 CYPRESS POINT PKWY STE A108
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-283-4932
Practice Address - Fax:386-283-4934
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3686237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist