Provider Demographics
NPI:1174186696
Name:GREWER, JENNIFER (HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GREWER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8038 MACINTOSH LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5336
Mailing Address - Country:US
Mailing Address - Phone:815-332-6800
Mailing Address - Fax:815-332-6810
Practice Address - Street 1:8038 MACINTOSH LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5336
Practice Address - Country:US
Practice Address - Phone:815-332-6800
Practice Address - Fax:815-332-6810
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3558237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist