Provider Demographics
NPI:1669457362
Name:SCHOLL, JENNIFER L (AUD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:SCHOLL
Suffix:
Gender:F
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A, F-AAA
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-9200
Mailing Address - Fax:907-842-9455
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9200
Practice Address - Fax:907-842-9455
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1000357Medicaid
AKTEZM52YK5LMedicare PIN
AKR117356Medicare PIN
AK000266Medicaid