Provider Demographics
NPI:1457841496
Name:FALCON, JENNICA R (AUD)
Entity Type:Individual
Prefix:
First Name:JENNICA
Middle Name:R
Last Name:FALCON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY STE 515
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1024
Mailing Address - Country:US
Mailing Address - Phone:512-454-0472
Mailing Address - Fax:512-371-7098
Practice Address - Street 1:5750 BALCONES DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4268
Practice Address - Country:US
Practice Address - Phone:512-836-8786
Practice Address - Fax:512-836-8794
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80952231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80952OtherSTATE LICENSE