Healthcare Provider Details

I. General information

NPI: 1861647935
Provider Name (Legal Business Name): JENNIFER BADILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 N FRAZIER ST
CONROE TX
77301-1347
US

IV. Provider business mailing address

5201 BELLAIRE BLVD
BELLAIRE TX
77401-3901
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-1050
  • Fax: 936-756-3534
Mailing address:
  • Phone: 713-666-1704
  • Fax: 713-666-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number80314
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: