Provider Demographics
NPI:1386908150
Name:CLARKE, JENNIFER L (AUD CCC-A)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CLARKE
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PACCHIANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD CCC-A
Mailing Address - Street 1:104 WOODMONT BLVD
Mailing Address - Street 2:LL50
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:615-386-2398
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:STE 400
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-2700
Practice Address - Fax:615-386-2399
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1659231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532846Medicaid
TN4360888OtherBLUECROSS BLUESHIELD TN
TN4360888OtherBLUECROSS BLUESHIELD TN
TN103I649222Medicare PIN