Provider Demographics
NPI:1396837241
Name:AUDETTE, JENNIFER (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AUDETTE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 AUSTINE DR STE 210
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6994
Practice Address - Country:US
Practice Address - Phone:802-254-3922
Practice Address - Fax:802-258-9512
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT68531OtherAUDIOLOGIST
NH30433510Medicaid
VT1011350Medicaid
VTVT9134Medicare PIN
VT68531OtherAUDIOLOGIST