Healthcare Provider Details

I. General information

NPI: 1801939681
Provider Name (Legal Business Name): JENNIFER E MCCLIMENT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER E DEAN

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 7TH AVE
FORT WORTH TX
76104-2733
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-4063
  • Fax: 682-885-1878
Mailing address:
  • Phone: 682-885-4432
  • Fax: 682-885-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51444
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: