Provider Demographics
NPI:1598198855
Name:PRUDEN, JENNIFER (MT-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2071
Mailing Address - Country:US
Mailing Address - Phone:317-378-4526
Mailing Address - Fax:
Practice Address - Street 1:621 S CULLEN AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4137
Practice Address - Country:US
Practice Address - Phone:812-491-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist