Provider Demographics
NPI:1700037793
Name:WHITEHEAD, JANE P
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1803
Mailing Address - Country:US
Mailing Address - Phone:860-928-7330
Mailing Address - Fax:860-928-1907
Practice Address - Street 1:145 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1803
Practice Address - Country:US
Practice Address - Phone:860-928-7330
Practice Address - Fax:860-928-1907
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT197231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter