Provider Demographics
NPI:1740854645
Name:BAIN, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E RIVERSIDE DR STE 3D
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6889
Mailing Address - Country:US
Mailing Address - Phone:435-674-9900
Mailing Address - Fax:435-634-9384
Practice Address - Street 1:157 E RIVERSIDE DR STE 3D
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6889
Practice Address - Country:US
Practice Address - Phone:435-674-9900
Practice Address - Fax:435-634-9384
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD-7176237700000X
NVHAS-0572237700000X
UT5324660-4601237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZHAD-7176OtherHEARING SPECIALIST
NVHAS-0572OtherHEARING AID SPECIALIST
UT5324660-4601OtherHEARING SPECIALIST