Healthcare Provider Details

I. General information

NPI: 1093093650
Provider Name (Legal Business Name): JENNIFER BROOKE ADAMS AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BROOKE FLEISCHMANN AUD, CCC-A

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E 80TH AVE
MERRILLVILLE IN
46410-5737
US

IV. Provider business mailing address

1609 E. 80TH AVE
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2730
  • Fax: 219-738-2743
Mailing address:
  • Phone: 219-738-7230
  • Fax: 219-738-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number563-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: