Provider Demographics
NPI:1740403997
Name:MCGLOTHLIN, JENNIFER ROMINE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROMINE
Last Name:MCGLOTHLIN
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 1:541 N MOUNT JULIET RD
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3873
Mailing Address - Country:US
Mailing Address - Phone:615-758-7118
Mailing Address - Fax:615-758-7113
Practice Address - Street 1:541 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 2204
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3873
Practice Address - Country:US
Practice Address - Phone:615-758-7118
Practice Address - Fax:615-758-7113
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1444231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I643779OtherMEDICARE PTAN