Provider Demographics
NPI:1073735197
Name:HAMSON, JENIFER JORDAN (PHD, ATC, LAT)
Entity Type:Individual
Prefix:PROF
First Name:JENIFER
Middle Name:JORDAN
Last Name:HAMSON
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 WILDERNESS ST.
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7620
Mailing Address - Country:US
Mailing Address - Phone:940-230-4929
Mailing Address - Fax:
Practice Address - Street 1:1413 WILDERNESS ST.
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7620
Practice Address - Country:US
Practice Address - Phone:940-230-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT37632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer