Provider Demographics
NPI:1770762569
Name:KING, JENNIFER RUTH (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:KING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CONGRESS PKWY N STE 200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-1694
Mailing Address - Country:US
Mailing Address - Phone:423-745-6222
Mailing Address - Fax:866-419-1447
Practice Address - Street 1:311 CONGRESS PKWY N STE 200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1694
Practice Address - Country:US
Practice Address - Phone:423-745-6222
Practice Address - Fax:866-419-1447
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1202231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4033915OtherBLUE CROSS BLUE SHIELD TN