Provider Demographics
NPI:1457330193
Name:EHLERS, JEANETTE
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:EHLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:HRUSKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:535 CEDAR CROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7704
Mailing Address - Country:US
Mailing Address - Phone:563-588-0506
Mailing Address - Fax:563-588-0451
Practice Address - Street 1:535 CEDAR CROSS ROAD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7704
Practice Address - Country:US
Practice Address - Phone:563-588-0506
Practice Address - Fax:563-588-0451
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00498237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12389OtherDEAN HEALTH PLAN
IA0202036Medicaid
IA42098297119OtherJOHN DEERE HEALTHCARE
IA42098297119OtherJOHN DEERE HEALTHCARE