Provider Demographics
NPI:1053467787
Name:MERTES, JENNIFER L (AUD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MERTES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8169 OLD MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7940
Mailing Address - Country:US
Mailing Address - Phone:410-696-3050
Mailing Address - Fax:410-696-3088
Practice Address - Street 1:8169 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:410-696-3050
Practice Address - Fax:410-696-3088
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01003231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist