Provider Demographics
NPI:1093093650
Name:ADAMS, JENNIFER BROOKE (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BROOKE
Other - Last Name:FLEISCHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1609 E. 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-738-7230
Mailing Address - Fax:219-738-2743
Practice Address - Street 1:1609 E 80TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5737
Practice Address - Country:US
Practice Address - Phone:219-738-2730
Practice Address - Fax:219-738-2743
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI563-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093093650Medicaid
WIP00972354OtherRAILROAD
WIP00972354OtherRAILROAD