Healthcare Provider Details

I. General information

NPI: 1407019441
Provider Name (Legal Business Name): BETH ANN JACQUES AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PILLSBURY ST
CONCORD NH
03301-3556
US

IV. Provider business mailing address

1 PILLSBURY ST
CONCORD NH
03301-3556
US

V. Phone/Fax

Practice location:
  • Phone: 603-856-8275
  • Fax: 603-219-0454
Mailing address:
  • Phone: 603-856-8275
  • Fax: 603-219-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA598
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: