NPIMap

Individual provider Active NPI

Jennie Lynn Mollerup, AU.D., CCC-A

  • Audiologist-Hearing Aid Fitter
  • Omak, WA
National Provider Identifier
1376662791
Registry record updated Feb 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
LD60323941 Issued in WA
Practice address
506 Riverside Drive
Suite B
Omak, WA 98841
Phone
(509) 826-7165
Fax
(509) 826-1179
NPI assigned
Mar 28, 2007
Last updated
Feb 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 56420554101 UT
Audiologist-Hearing Aid Fitter 237600000X LD60323941 WA Primary

Addresses

Primary practice location

506 Riverside Drive
Suite B
Omak, WA 98841

Mailing address

208 S Main St # 29
Omak, WA 98841-9755
Phone (509) 322-5995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
56420554101UTMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hearing Zone Inc Audiologist-Hearing Aid Fitter Past Accepting new patients
Robinson Audiology, LLC. Audiologist-Hearing Aid Fitter Past Accepting new patients
Moomaw Hearing Center Inc Audiologist Past Accepting new patients
Lakeside Audiology LLC Audiologist-Hearing Aid Fitter Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1376662791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 S MAIN ST # 29",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419755",
            "telephone_number": "509-322-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 RIVERSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-826-7165",
            "fax_number": "509-826-1179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLERUP",
        "first_name": "JENNIE",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "AU.D., CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "UT",
            "license": "56420554101",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WA",
            "license": "LD60323941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.