Individual
JANE A EHNSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC A
Contact information
Practice address
48 ELM ST, WORCESTER, MA 01609-2541
(508) 757-0330
(508) 754-9426
Mailing address
48 ELM ST, WORCESTER, MA 01609-2541
(508) 757-0330
(508) 754-9426
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
324
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
THREE RIVERS
—
01
—
042472266039
TRICARE CHAMPUS
—
05
—
5104424
—
MA
01
—
54936
FALLON COMMUNITY HEALTH P
—
01
—
7941616
AETNA US HEALTHCARE
—
01
—
AA3440
HARVARD PILGRIM HEALTHCAR
—
01
—
AD0171
BLUE SHIELD IDEMNITY
—
Enumeration date
11/16/2005
Last updated
08/25/2009
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