MEDICARE: MRS. JENNIFER MELISSA CRESPO M.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	237600000X	Audiologist-Hearing Aid Fitter	AU 2663	CA
2	231H00000X	Audiologist	AU2663	CA

General Provider Information

NPI Number	:	1740629518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MELISSA CRESPO M.A.

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD STE 401
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8123
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	411 E HUNTINGTON DR STE 121
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91006-3788
Country	:	US
Telephone Number	:	626-574-3138
Fax Number	:	626-574-3195

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	12/13/2019

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