Provider Demographics
NPI:1992160469
Name:FINCH, JENNILYN (HIS)
Entity type:Individual
Prefix:
First Name:JENNILYN
Middle Name:
Last Name:FINCH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4056
Mailing Address - Country:US
Mailing Address - Phone:321-914-0810
Mailing Address - Fax:321-914-0821
Practice Address - Street 1:1106 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4056
Practice Address - Country:US
Practice Address - Phone:321-914-0810
Practice Address - Fax:321-914-0821
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5152237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist