Healthcare Provider Details

I. General information

NPI: 1710933577
Provider Name (Legal Business Name): JENIFER WOO CUSHING AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 KINGFISHER DR STE 27
FREDERICK MD
21701-4771
US

IV. Provider business mailing address

19110 MONTGOMERY VILLAGE AVE STE 120
MONTGOMERY VILLAGE MD
20886-3706
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-0222
  • Fax: 301-846-7707
Mailing address:
  • Phone: 301-977-6317
  • Fax: 301-977-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01081
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: