Provider Demographics
NPI:1891257242
Name:KEYES, JENNIFER G (HAS, BC-HIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:KEYES
Suffix:
Gender:F
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 ATLANTIC BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3199
Mailing Address - Country:US
Mailing Address - Phone:904-221-1577
Mailing Address - Fax:904-221-1579
Practice Address - Street 1:12740 ATLANTIC BLVD STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3199
Practice Address - Country:US
Practice Address - Phone:904-221-1577
Practice Address - Fax:904-221-1579
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5091237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist