Provider Demographics
NPI:1265459739
Name:JENNINGS, EVELYN W (MA AUDIOLOGY)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:W
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA AUDIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:106 SYLVIS STREET
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055
Mailing Address - Country:US
Mailing Address - Phone:615-446-8564
Mailing Address - Fax:615-446-3983
Practice Address - Street 1:106 SYLVIS STREET
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-446-8564
Practice Address - Fax:615-446-3983
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3192256Medicare ID - Type Unspecified