Provider Demographics
NPI:1497843791
Name:CARTER, JENNIFER ROSE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 5TH AVE STE 421
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2841
Mailing Address - Country:US
Mailing Address - Phone:509-835-5111
Mailing Address - Fax:509-835-5222
Practice Address - Street 1:801 W 5TH AVE STE 421
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2841
Practice Address - Country:US
Practice Address - Phone:509-835-5111
Practice Address - Fax:509-835-5222
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002687231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8870272OtherMEDICARE
WA8502536Medicaid