Provider Demographics
NPI:1083744320
Name:VANDERFEEN, JESSICA JOAN (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOAN
Last Name:VANDERFEEN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N MAIN ST
Mailing Address - Street 2:AMERICAN SCHOOL FOR THE DEAF
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1264
Mailing Address - Country:US
Mailing Address - Phone:860-570-2318
Mailing Address - Fax:860-570-2271
Practice Address - Street 1:139 N MAIN ST
Practice Address - Street 2:AMERICAN SCHOOL FOR THE DEAF
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1264
Practice Address - Country:US
Practice Address - Phone:860-570-2318
Practice Address - Fax:860-570-2271
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000351231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11220528OtherCAQH