Provider Demographics
NPI:1376699231
Name:KINGSBURY, JENNY LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 LEIGH ANN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-3789
Mailing Address - Country:US
Mailing Address - Phone:931-906-0723
Mailing Address - Fax:
Practice Address - Street 1:1740 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4561
Practice Address - Country:US
Practice Address - Phone:931-645-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA0000001467231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist