Provider Demographics
NPI:1669088985
Name:MIDDLEBROOKS, JENNIFER LYNN (HID)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 BOAT CLUB RD STE 257
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7023
Mailing Address - Country:US
Mailing Address - Phone:817-346-6464
Mailing Address - Fax:817-238-0054
Practice Address - Street 1:4625 BOAT CLUB RD STE 257
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7023
Practice Address - Country:US
Practice Address - Phone:817-346-6464
Practice Address - Fax:817-238-0054
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80885237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty