Provider Demographics
NPI:1679916209
Name:DYE, JENNIFER
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 US HIGHWAY 31 S
Mailing Address - Street 2:SUITE I
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3062
Mailing Address - Country:US
Mailing Address - Phone:317-882-9151
Mailing Address - Fax:
Practice Address - Street 1:640 US HIGHWAY 31 S
Practice Address - Street 2:SUITE I
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3062
Practice Address - Country:US
Practice Address - Phone:317-882-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001220A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist