Provider Demographics
NPI:1558529552
Name:HENSON, JENNIFER A (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HENSON
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 W STATE ST
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1610
Mailing Address - Country:US
Mailing Address - Phone:423-968-7555
Mailing Address - Fax:423-968-7641
Practice Address - Street 1:3185 W STATE ST
Practice Address - Street 2:SUITE 2010
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1610
Practice Address - Country:US
Practice Address - Phone:423-968-7555
Practice Address - Fax:423-968-7641
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001302237600000X
TN1193231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC12692Medicare PIN