Provider Demographics
NPI:1376705046
Name:REARDON, JESSICA J
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:REARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:TRIEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MAIN ST
Mailing Address - Street 2:P.O. BOX 956
Mailing Address - City:WEST NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985-1420
Mailing Address - Country:US
Mailing Address - Phone:978-363-5553
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01985-1420
Practice Address - Country:US
Practice Address - Phone:978-363-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist