Provider Demographics
NPI:1023232964
Name:LONDA, JESSICA BETH (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BETH
Last Name:LONDA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05074-0123
Mailing Address - Country:US
Mailing Address - Phone:802-785-2434
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 113
Practice Address - Street 2:
Practice Address - City:THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05074-0123
Practice Address - Country:US
Practice Address - Phone:802-785-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT765103TC0700X
NH915103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical