Provider Demographics
NPI:1821509357
Name:STROM, JENNIFER DIANE (HAS-APPRENTICE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:STROM
Suffix:
Gender:F
Credentials:HAS-APPRENTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PINION RD STE D
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8319
Mailing Address - Country:US
Mailing Address - Phone:775-738-4227
Mailing Address - Fax:775-738-4284
Practice Address - Street 1:1825 PINION RD STE D
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8319
Practice Address - Country:US
Practice Address - Phone:775-738-4227
Practice Address - Fax:775-738-4227
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-05782355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant