Healthcare Provider Details

I. General information

NPI: 1467420216
Provider Name (Legal Business Name): JENNY DAVIES HEAD AUD CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY F DAVIES

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 ED DR
RALEIGH NC
27612-8037
US

IV. Provider business mailing address

3820 ED DR
RALEIGH NC
27612-8037
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-9003
  • Fax: 919-782-9303
Mailing address:
  • Phone: 919-782-9003
  • Fax: 919-782-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3805
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number3805
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number3805
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number3805
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3805
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number3805
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: