MEDICARE: JENNIFER WICKESBERG AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	51231	TX
2	237700000X	Hearing Instrument Specialist	51231	TX
3	231H00000X	Audiologist	51231	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497716773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WICKESBERG AU.D.

Provider Business Mailing Address
First Line	:	1417 HOUSTON AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6237
Country	:	US
Telephone Number	:	713-523-3633
Fax Number	:	713-523-8399

Provider Business Practice Location Address
First Line	:	3636 W DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-1704
Country	:	US
Telephone Number	:	713-523-4722
Fax Number	:	713-523-8399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/19/2020

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