Healthcare Provider Details

I. General information

NPI: 1255484549
Provider Name (Legal Business Name): MEGHAN KATHLEEN JENSEN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAN KATHLEEN DREXEL CCC-A

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 GOLD HILL RD SUITE 104
FORT MILL SC
29708-8985
US

IV. Provider business mailing address

870 GOLD HILL RD #104
FORT MILL SC
29708-8985
US

V. Phone/Fax

Practice location:
  • Phone: 803-620-8250
  • Fax: 803-638-6901
Mailing address:
  • Phone: 803-620-8250
  • Fax: 803-638-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number4055
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number6624
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6624
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4055
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: