Provider Demographics
NPI:1528268992
Name:PRUDEN, JINGER RENEE (MA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:JINGER
Middle Name:RENEE
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MRS
Other - First Name:JINGER
Other - Middle Name:RENEE
Other - Last Name:PRUDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-A
Mailing Address - Street 1:350 HENRY CLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1024
Mailing Address - Country:US
Mailing Address - Phone:859-268-4545
Mailing Address - Fax:859-269-1857
Practice Address - Street 1:350 HENRY CLAY BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1024
Practice Address - Country:US
Practice Address - Phone:859-268-4545
Practice Address - Fax:859-269-1857
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0409231H00000X
KYHISHSP00218694237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN