Provider Demographics
NPI:1790932275
Name:DUPRE, JENNIFER C (AUD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:DUPRE
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 1:6330 WEST LOOP S STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2936
Mailing Address - Country:US
Mailing Address - Phone:832-828-5444
Mailing Address - Fax:832-825-9591
Practice Address - Street 1:6330 WEST LOOP S STE 300
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2936
Practice Address - Country:US
Practice Address - Phone:832-828-5444
Practice Address - Fax:832-825-9591
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80280231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05185894Medicaid
LA1315362Medicaid
LA3A857Medicare PIN
MS05185894Medicaid