Provider Demographics
NPI:1639158967
Name:WHEELOCK, JENNIFER DYE (CCC-A, AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DYE
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:CCC-A, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2793
Mailing Address - Country:US
Mailing Address - Phone:502-584-3573
Mailing Address - Fax:502-515-3325
Practice Address - Street 1:111 E KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2793
Practice Address - Country:US
Practice Address - Phone:502-584-3573
Practice Address - Fax:502-515-3325
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002340A231H00000X
KY0467231H00000X
KY0929237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00136043OtherRAILROAD / TRAVELER
IN200137900AMedicaid
IN000000352564OtherANTHEM
INP00136043OtherRAILROAD / TRAVELER