Provider Demographics
NPI:1477684199
Name:HARTZE, JENNIFER L (AUD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:HARTZE
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 1:317 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1810
Mailing Address - Country:US
Mailing Address - Phone:406-549-1951
Mailing Address - Fax:406-542-5682
Practice Address - Street 1:317 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1810
Practice Address - Country:US
Practice Address - Phone:406-549-1951
Practice Address - Fax:406-542-5682
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT248237600000X
MT734231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT29478OtherBCBS ALLIED PROVIDER
MT5602792Medicaid
MT0533273Medicaid
MT248OtherHEARING AID LIC
MT734OtherAUDIOLOGY LIC
MT011003555Medicare PIN
MT248OtherHEARING AID LIC