MEDICARE: MS. JENNIFER LUNDGREN GARCIA AU.D.

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	698	MA

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

General Provider Information

NPI Number	:	1255338380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LUNDGREN GARCIA AU.D.

Provider Business Mailing Address
First Line	:	200 N MAIN ST
Second Line	:	NORTH BUILDING, SUITE 103
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2392
Country	:	US
Telephone Number	:	413-525-7979
Fax Number	:	413-525-8303

Provider Business Practice Location Address
First Line	:	200 N MAIN ST
Second Line	:	# N103
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2392
Country	:	US
Telephone Number	:	413-525-7979
Fax Number	:	413-525-8303

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/20/2010

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