Healthcare Provider Details

I. General information

NPI: 1558529552
Provider Name (Legal Business Name): JENNIFER A. HENSON M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W STATE ST SUITE 2010
BRISTOL TN
37620-1610
US

IV. Provider business mailing address

3185 W STATE ST SUITE 2010
BRISTOL TN
37620-1610
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-7555
  • Fax: 423-968-7641
Mailing address:
  • Phone: 423-968-7555
  • Fax: 423-968-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1193
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2201001302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: