Provider Demographics
NPI:1952556532
Name:WALTERS, JACQUELYN (AUD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:HEEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5103 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3062
Mailing Address - Country:US
Mailing Address - Phone:833-354-1492
Mailing Address - Fax:
Practice Address - Street 1:5359 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2738
Practice Address - Country:US
Practice Address - Phone:563-232-1404
Practice Address - Fax:535-232-1403
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100401231HA2400X, 237600000X, 231H00000X
IA100424237600000X
NVA-211 DISPENSING237600000X
NVA-211231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter