MEDICARE: MRS. JENNIFER BROOKE ADAMS AUD, CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	563-156	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00972354	OTHER	WI	RAILROAD

General Provider Information

NPI Number	:	1093093650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER BROOKE ADAMS AUD, CCC-A

Provider Business Mailing Address
First Line	:	1609 E. 80TH AVE
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410
Country	:	US
Telephone Number	:	219-738-7230
Fax Number	:	219-738-2743

Provider Business Practice Location Address
First Line	:	1609 E 80TH AVE
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5737
Country	:	US
Telephone Number	:	219-738-2730
Fax Number	:	219-738-2743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	04/14/2014

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Directions to “ MRS. JENNIFER BROOKE ADAMS AUD, CCC-A” Practice Location

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