Provider Demographics
NPI:1255484549
Name:JENSEN, MEGHAN KATHLEEN (AUD)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:MEGHAN
Other - Middle Name:KATHLEEN
Other - Last Name:DREXEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-A
Mailing Address - Street 1:870 GOLD HILL RD
Mailing Address - Street 2:#104
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8985
Mailing Address - Country:US
Mailing Address - Phone:803-620-8250
Mailing Address - Fax:803-638-6901
Practice Address - Street 1:870 GOLD HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8985
Practice Address - Country:US
Practice Address - Phone:803-620-8250
Practice Address - Fax:803-638-6901
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4055237600000X, 231H00000X
NC6624231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1690Medicaid
SCSA1690Medicaid