Provider Demographics
NPI:1760408546
Name:GAFFEY, JILL (MS CCC A)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:GAFFEY
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 1:125 DEAD HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422
Mailing Address - Country:US
Mailing Address - Phone:860-349-8709
Mailing Address - Fax:
Practice Address - Street 1:198 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-346-5428
Practice Address - Fax:860-346-0201
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT85231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
730000085CT01OtherBLUE CROSS BLUE SHIELD
OV5601OtherHEALTH NET