Provider Demographics
NPI:1083744320
Name:VANDERFEEN, JESSICA J (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:VANDERFEEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:860-570-2318
Mailing Address - Fax:860-570-2271
Practice Address - Street 1:440 N MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-893-1977
Practice Address - Fax:860-845-5330
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
CT000351231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004207644Medicaid
CT11220528OtherCAQH