Provider Demographics
NPI:1467420216
Name:HEAD, JENNY DAVIES (AUD CCCA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:DAVIES
Last Name:HEAD
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:F
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3820 ED DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8037
Mailing Address - Country:US
Mailing Address - Phone:919-782-9003
Mailing Address - Fax:919-782-9303
Practice Address - Street 1:3820 ED DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8037
Practice Address - Country:US
Practice Address - Phone:919-782-9003
Practice Address - Fax:919-782-9303
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3805231H00000X, 231HA2400X, 231HA2500X, 237600000X, 237700000X, 235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001501Medicaid