Provider Demographics
NPI:1366502387
Name:HURST, JENNIFER (AUD AUDIOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:AUD AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 EAGLE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-9058
Mailing Address - Country:US
Mailing Address - Phone:970-444-2124
Mailing Address - Fax:
Practice Address - Street 1:2343 EAGLE DR UNIT A
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9058
Practice Address - Country:US
Practice Address - Phone:970-444-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAUD3121231H00000X, 237600000X
COAUD.0000905237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91056519Medicaid